Neck Muscle Injury

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    Neck Muscle Injury

    Sorry this is a long post...

    I have been having a problem with an old neck muscle injury that I can't seem to control very well and was wondering if anyone has had to deal with something similar or might could offer some advice that might help as it is a very annoying thing to deal with from one day to the next.

    Some time around September-December 2002, I injured my neck doing an incline bench press. The pain I experience runs along a line from the middle part of my jaw bone straight down along roughly the location of the carotid artery ending around my collar bone. You know where you would feel to check your pulse? Well put your hand there and push inward a bit. Right there I feel a constant lump in my throat. I feel this normally and especially when I swallow. Otherwise it is just a dull constant ache. Sometimes that muscle feels tight.

    Here is what I have done about it to date and a little more about the symptoms as I have paid fairly close attention to it over time.

    Medically:

    1) Had an MRI of the neck. Came back completely normal
    2) Took x-rays. Nothing showed up.
    3) Did a barium swallow to check for espohageal issues. No problem with swallowing etc. In fact the specific muscle I use to swallow doesn't seem to be the injured muscle at all. I can control the swallowing without influencing the feeling of the lump if I have to. Tough to describe...
    4) Went to see an otolaryngologist. He ran a check of my vocal cords, stuck tube down nose, again all is normal. Never once have I had a speech problem due to this.
    5) Medications I have 'briefly' tried muscle relaxers and anti-inflamatories (vioxx, zanaflex, aspirin specifically). I haven't noticed relief from these though I haven't taken them for more than about 2 weeks at a time though.
    6) I went to see an orthopeodic sports medicine specialist and described all physical aspects of the injury I could. He was not sure what else to try save possibly some physical therapy of some sort.
    7) Both my GP and the sports medicine specialist said the same thing. Normally these types of injuries heal on their own. Especially muscle injuries. Surgery is rarely used. I figured it would get better in time also. Apparently not.

    From my own experience:

    1) Given my medical diagnosis, I tend to think this may very well be muscular in nature. The tests I have had run couldn't check for a specific muscle injury. So many little muscles in the neck.
    2) The injury is aggravated by heat. A hot shower, a hot cup of coffee or other hot food aggravate it. Cardiovascular work like bike riding, running etc. Anything that gets too much blood flowing seems to inflame and tighten the area somewhat. High rep, depletion style weight training with little rest b/w sets seems to inflame it. So this tends to make cardio and higher rep work somewhat unenjoyable.
    3). Regarding weight training. I took 3-4 weeks off right after the injury to let it heal. Didn't help. I took 2 whole months off of training in July and August of 2003. Didn't help. Low rep strength training type work hasn't bothered the injury to any great extent. Deadlifting, wearing a backpack, squatting..those types of activities slightly stretch the muscle while I am doing it but don't seem to really aggravate it. i.e. I don't feel worse afterwards.
    4) Weather is a huge issue. It felt much better in the winter or any time it was cold outside. Even remotely warm weather brings on a lot of annoyance.
    5) It usually feels better upon waking. I tend to sleep with that muscle in an unstretched position. I.e. sleeping on stomach with head turned toward left chest area. Relieves tension on that muscle.
    6)Even sitting in a chair at a computer can be a problem. It probably feels best when I am standing and there is little pressure on it.
    7) Very cold food tends to help, like ice cream bars. I have also thought of trying a cool pack around my neck. Since the muscle is pretty deep in my neck surface coolness like that seems to take some time for even minor relief. Not sure I want to walk around with a collar on my neck all day either!
    8)Chewing gum and constantly chewing foods seems to help a fair amount.
    9) Drinking ice cold drinks obviously may help.

    What I am looking for is at least two-fold. I really want to take a more proactive stance at combating this problem. I would also like to figure out more about what my specific injury may be. Everything I have tried so far seems to only provide at best temporary relief. I can't see my way to a more permanent solution. If I could I would pursue it most definitely. Right now, I am focusing on a stretching regimen for that part of the neck to see how that helps.

    Part of me thinks that it is just my everyday activities of life that are aggravating it. If darn near everything I do could irritate it, I don't see how I can heal it short of longterm bedrest lol. I am also wondering if it could somehow be nerve related or if it could just be pressing places in my neck that cause referred pain somehow.

    So if you have any ideas about my problem or could help me better focus my efforts at improving this condition, I would love to hear them. I am open to anything that may help.

    A sincere thanks in advance for this one!

    -Cardinal

    Any links to sites with more info on this type of injury would defnitely help. Most of what I have found thus far seems to focus on short term relief or prophylactic measures. Doesn't address such a chronic problem that won't go away.

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    Wish I could help but you've done everything I can think of....

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    I'm glad they ruled out carotidynia and neck masses with the MRI. I am still worried that you have a variant of three syndromes:

    ERNEST SYNDROME:
    Mandibular ligament that connects the base of the skull with the mandibular. this can cause pain int he throat when swallowing and the lower back teeth and jaw bone
    or
    EAGLE'S SYNDROME:
    Elongated styloid process or calcified stylohyoid ligament.

    and symptoms include a foreign body lodged in the throat, or neck pain along the distribution of the carotid artery, therefore a constant dull throat ache, ear pain, difficulty with swallowing,and sometimes headache.
    The stylohyoid ligament originates from the tip of the styloid process of the temporal bone and ends by attaching to the hyoid Treatment is surgical resection of the styloid process and ossified stylohyoid ligament.

    HYOID BONE SYNDROME:
    Only bone in body that does not articulate with any other bone.

    Symptoms: chronic constant pain in the lateral side of the throat that radiates to the ear, throat, temple, cheek and TMJ. Pain in the lower molar teeth. upper chest pain. Rarely, dizziness or fainting when turning the head towards the injured side. Pain when swallowing. Chronic sore throat, difficult or tightens when swallowing

    A ENT may be able to help with the above:



    Or you may have myofascial pain associated with the sternocleidomastoid neck muscle and a more holistic approach (accupuncture, chiropractor, massage therapy) may help. Good luck. It sounds aggravating.

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    Bandaidwoman, General Health & Awareness would be lost without you.

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    Bandaidwoman:

    Thank you so much for your help with this! What you describe here matches my symptoms almost exactly! It is bound to be one of those variants.

    I tried to do some similar research a long while ago and just ended up more confused than anything. I was looking at the wrong disorders.

    From what I can tell Eagle's syndrome seems to be the best fit. I'll decide on what type of medical specialist to see (ENT most likely...not the one I was going to as he seems clueless).

    What you posted gave me a jump start on all kinds of things to research and I know a lot more already about what kinds of test need to be run to nail down my exact problem. I can also see how they are all inner connected in a way.

    Something like a simple radiography will probably be a first step. Along with a palpation of the styloid process if needed to diganose things. Coolness.

    Again, thank you very much! This is ridiculously helpful.

    -Cardinal

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    dpending on where the MRI sections were shot, any calcifications or an enlogated styloid process should have been seen, hopefully.

    this is the only thing keeping me from believing that is what it is...

    so many conditions present with similar symptoms that sometimes you can make yourself crazy trying to self diagnose....it makes doctors crazy as well sometimes!

    the fact that it happened all of a sudden, while you were lifting makes me believe it was trauma induced and not one of these syndromes, as they most likely would't have had such an acute onset (they might, but not likely)

    i think, like bandaidwoman said, it is probably muscular in nature...maybe a tear...sometimes if a few fibers tear they can roll up and present as a knot.

    one way to maybe check if it your SCM.....try rotating your head as far as you can to the left and right against some resistance (put your hand on your face and apply pressure opposite the way you turn)....does that make the symptoms worse?

    as in any case, nothing is black and white and the fact that your condition is influenced so much by the temperature is a bit puzzling...so try the SCM test and let me know what happened.

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    Sorry for the terse reply but I am headed out the door to see my doctor as we speak. I tried the test and feel no pain whatsoever from doing that.

    When I get back I will attempt to do a better job at explaining the symptoms, especially what it feels like to bench press now vs. before the injury.

    I'll talk to the doc about different treatment options and try to get some additional tests scheduled if he thinks they are warranted.

    Thanks for the info!

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    good luck to you....hope to hear good news when you get back!

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    Had a good visit with my ortho sports medicine specialist. There were three doctors in the room at the time so we all ended up talking for about 1/2 hour or so. Good stuff.

    They each did a comprehensive physical exam of the neck area. They noticed a small lump where the lymph area is that wasn't there before on prior exams. This is also the first time I have noticed it.

    Most likely he is going to schedule another MRI. First he plans to speak with my ENT to get his opinion if another is needed. He also is going to talk with an oral surgeon to get his take on it. None of the three could really discern anything specific.

    I told them about all suggestions listed above. Given that chewing seems to improve it, the doc thinks it 'might' not be certain TMJ type disorders but was definitely intrigued by the info about styloid process and also agreed that it could still easily be a muscle tear.

    I suggested a few new ideas...namely the possibility of a panorex radiograph, a prone CAT scan (he thinks MRI is going to be better), and palpation of the tonsillar fossa.

    I'll get a call from him within the next day or two when he has had a chance to mull over it more.

    The temperature issue was confounding to them as well.

    Glad they noticed the little lump whether it happens to be related to my condition or not.

    Heck now I am getting even more interested in all this.

    -Cardinal

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    be sure to keep us posted!
    sounds like good progress...at least steps in the right direction

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    Well it has been 2 months since I posted this thread and I have a more definitive diagnosis. I had a second MRI, this time with contrast dye that came back perfectly normal. I also have gone to see a chiropractor and a M.D. with a physical therapy specialty.

    Both concluded that same thing: My pain results from an injury to the omohyoid muscle specifically. Both doctors came to this conclusion independently. I have gone through 3 weeks of myofascial release/laser therapy that did not improve or disprove the condition. That muscle is too deep for the chiro to treat in that manner.

    My physical therapy doc is reluctant to try a trigger point injection (w/steroid) since the muscle is located b/h the jugular and in the same plane as the carotid.

    I am at a point where I could definitely use more advice if anyone has ideas (drchiro, bandaidwoman, others?).

    My plan as of right now:

    1) Do my own version of myofascial release/stretching of the muscle. Prescription from doc is something like 3x5, with 15 seconds time under tension done 3x/ED. I would of course know best when I am working/stretching the correct muscle.

    2) Go for a solid month on muscle relaxants, scalaxin(sp) dosed 1-2x/ED to see if there is improvement

    3) Try to avoid excessive heat and overuse of muscles lifting

    4) Trigger point injection in a safer area in early June. Need help with some ideas on where might be effective as the locus of pain is pretty much out of the qtn due to safety issues.

    Anyone else able to brainstorm something up that might help? Thanks in advance. This is definitely a bit frustrating considering I was really counting on being able to use the injections to help with this one.

    -Cardinal

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    Go to an accupuncurist! I'm somewhat prejudiced since I am from the Far east, but they may indirectly provide the trigger point so to speak by working with the meridians. Before you pooh pooh it, some anesthesiologists are doing fellowships in accupuntcure (In china they do open heart using accupuncture for anesthesia.0

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    Originally posted by bandaidwoman
    In china they do open heart using accupuncture for anesthesia.0
    That is amazing.

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    I am a big believer in accupuncture as well..hell, its worth a shot.

    I do think that your idea of what to do sounds pretty good though...i would try to avoid the injection if possible....doing the rest of your plan and given some time, I feel it should get better.

    I have actually never encountered someone with a omohyoid problem....now I know what to look for and keep an eye out for it...so thank you for sharing your experience. When I think "omohyoid" I get flashbacks of gross anatomy lab...glad thats over with!

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    Thanks for all of the information. I honestly had not considered acupuncture until it was mentioned here. Any tips on what to look for in a good acupuncturist. Licencing/accreditation etc? I am going to check here in Tyler, TX to see if there are any practicing. My intuition tells me to handle it in the usual manner. Get a referral from one of my doc's just like I would to see a specialist.

    I'll definitely go with the ideas I presented using my own myofascial release type work. But I am not so confident that the muscle relaxers or that will be highly successful in the shortrun since I have had this thing now for a good 20 months with no improvement or disprovement.

    Once again thanks. Sorry I didn't get to this response faster. It has been a hectic couple of days around here.

    -Cardinal

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