Neck-Tongue Syndrome treated with Prolotherapy

What is Neck-Tongue Syndrome?

We see all sorts of patients with a wide variety of conditions here at Caring Medical. One very rare, but very interesting condition is Neck-tongue syndrome. Neck-tongue syndrome is an uncommon condition characterized by pain on one side of the neck with or without numbness in the neck, accompanied by simultaneous numbness of the tongue on the same side as the neck pain. The symptoms occur with sharp turning of the neck. The neck pain is generally felt in the sub-occipital region. Tongue spasms may occur in some cases. Neck-tongue syndrome has been seen in instances of arthritis affecting the C1-2-3 articulation.

neck-tongue-syndrome-WEBThis syndrome is noted in patients with degenerative disease of the neck, but also in those without it. Many of the documented cases of neck-tongue syndrome occur in otherwise normal, young adults. Neck-tongue syndrome is divided into two categories. Complicated neck-tongue syndrome consists of those cases where there is presence of an underlying disease process, such as degeneration or inflammatory pathology.Uncomplicated neck-tongue syndrome is trauma related or idiopathic.

What is the cause of neck-tongue syndrome?

The probable cause of neck-tongue syndrome is compression of the 2nd and 3rd cervical root in its course between the atlas and axis during sharp neck rotation. “Abnormal subluxation of the lateral atlanto-axial joint upon rotation of the head, strains the joint capsule, and causes pain. When subluxed, there is impaction of the C2 ventral ramus against the articular processes of the lateral atlanto-axial joint.”

“Afferent fibers from the lingual nerve traveling via the hypoglossal nerve to the second cervical root provide a plausible explanation for compression of that root causing the numbness of half of the tongue.”

Documented cases and symptoms of neck-tongue syndrome

Orrell and Marsden documented two cases of neck-tongue syndrome involving severe pain at the occiput with numbness to the tongue and palate. In both of these cases, treatment involved having the patients wear cervical collars at all times. This reportedly controlled the symptoms.

Webb et al. also examined cases of neck-tongue syndrome in the Journal of Rheumatology in 1984.

The probable cause of neck-tongue syndrome concluded by Webb et al: “The lingual nerve has communication loops with the hypoglossal nerve as the 2 pass together over the hypoglossus muscle below the tongue; a similar communication occurs between the hypoglossal nerve and a loop connecting the 1st, 2nd, and 3rd cervical nerve roots. These intercommunications would allow the possibility of sensory disturbance to be experienced along ½ the tongue whenever there was compression or other irritation of the 2nd or 3rd cervical root nerve.”

Many of the subjects in the various studies experienced high cervical pain radiating to the same side of the tongue with the experiences lasting about 3 minutes or less.

Trauma as a cause of neck-tongue syndrome: 2 cases by Lance and Anthony

In this study by Lance and Anthony, neck-tongue syndrome is described as “attributable to instability of the upper cervical spine causing unilateral compression of the 2nd and possibly 3rd cervical root.” Lance and Anthony concluded, “The mechanical disability of the upper cervical spine that induces compression of the second cervical root on sudden rotation of the neck almost certainly involves some degree of unilateral subluxation of the facets of the atlantoaxial joint and instability of the upper cervical spine. The instability causes asymmetrical slipping of the atlantoaxial facets.”

atlantoaxial-instability-WEBCauses and treatments for neck-tongue syndrome: Instability of C1-C2 treated with Prolotherapy

A person with instability of the upper cervical spine, or C1-C2 (atlanto-axial) instability, a rapid rotation of the head can cause the symptoms of neck-tongue syndrome. (See Figure.)  Although such treatments as utilizing a cervical collar, performing isometric neck exercises, and posture control, are important modalities in C1-C2 instability, they do not treat the root of the problem of neck tongue syndrome.  They also provide only temporary relief.

It is our opinion that stabilization of the atlantoaxial facets is what is necessary to resolve neck-tongue syndrome. A more permanent solution option to consider is Prolotherapy. These regenerative injections directed at the weakened ligaments can stimulate fibroblastic growth and repair of the subluxed, unstable atlantoaxial areas. Prolotherapy can help the symptoms of neck-tongue syndrome by stabilizing the excessive movement at the atlantoaxial facets.

 

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