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Neck Muscle Injury

Cardinal

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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.
 

Jezziah

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

bandaidwoman

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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.
 

Jezziah

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

Cardinal

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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
 

DrChiro

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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.
 

Cardinal

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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!
 

DrChiro

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

Cardinal

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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
 

DrChiro

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

Cardinal

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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
 

bandaidwoman

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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
 

DrChiro

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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!
 

Cardinal

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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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This is an old thread but I have had similar pain for months and found this post while searching on carotidynia.

Cardinal, I see you're online - what turned out to help you the most?

Thanks,
Irene
 

Cardinal

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Irene,

I have had a couple of questions about this lately actually.

For the diagnosis, what helped me most was finding the right doctor who knew what he was doing. An ENT will often follow a different diagnosis procedure than other doctors will. You may need to see several different types of doctors before you find one that will correctly diagnose and know how to treat your injury. For me it took a doctor of physical therapy about 15 minutes to diagnose that I had an omohyoid muscle injury. I had gone to see several docs before that and they didn't have a decent guess at what it could be. The omohyoid injury was independently confirmed by a chiro also. After more than 3 years I still have no reason to doubt the diagnosis.

Time and peace of mind (knowing what the injury was) did more than anything to help with this one. 1-1.5 years after the injury and things were pretty much as they are now.

A little neural rewiring/pain desensitization may have helped too. I tend not to feel it now unless I think about it. I still feel a lump in my throat, but don't notice it unless I start thinking about the injury. Sleeping position helped with the pain also. I would keep from stretching the muscle while sleeping (I slept on my stomach with my head tucked into my collar bone).

Strengthening the muscle via whole body cns stimulation seems to make little difference (my neck and whole body is far stronger than it was three years ago). I never extensively tried muscle relaxer or pain killers. I viewed them as a means to mask the pain rather than get rid of it, so I just didn't bother. In any event it doesn't appear they were necessary.

Certainly I needed to avoid some gym lifts for awhile. Now nothing I train aggravates the injury.

My doctor said that if I was going to reinjure my neck I would have done it before I saw him since I had been deadlifting/BPing, squatting etc, with the injury.

He was right on that account too. I haven't reinjured it all.

I never ended up trying accupuncture or ART or anything like that. Certainly it is worth a shot though if you need it.

Hope this helps...

-Cardinal
 

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Thanks for your reply. I sleep exactly the same way lol. I think this happened during a hectic period singing while not well and out in the cold (pretty sure I know when it all started, I sing in a couple of bands).

I do some weight-training (just light stuff to stay toned really) and that does not seem to aggravate anything, just always feel it when I swallow, but of more concern to me, it actually hurts when I sing. On my dr's advice, took ibuprofen for three weeks, did not make anything go away though. He has given me stronger anti-inflammatories now, but I have not started them. It just seems like they are a bandaid.

Thanks though for the good ideas and alternate diagnosis I found in this thread. :) Will wait to see the ENT and explore some alternatives in the meantime.

Irene
 

KellyT

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Neck/Throat problem

Hi Cardinal,

I have the exact symptoms as you described and they are aggravated by the heat? Did you ever find anything that helped? My symptoms have been going on for 3 months and besides GERD, have not found anything yet that can explain the symptoms. Are you still having problems? Any suggestions?

Kelly
 

RegularOleJoe

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My search lands me here. Same Issue!

Well my search web-wide sent me here. I'm having pretty much the exact same symptoms/neck problems nearly word for word. I have to go out of town tomorrow and I'm sure a 747 will not aid in my neck pain or lump/gland flaring!

Got a heat pad from wally world, took some tylenol, taking friday off. My only guess is that will be temporary fix.

I'm guessing some of you out there may have a slight ache/pain sometimes when swallowing, mainly food??...

Thanks!
 

Cardinal

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Kelly,

Nothing new to report since February. I rarely think about but still feel a constant lump in my throat.

RegularOleJoe,

All I can say is that time makes it better.

In my case it was the result of a direct muscular injury. If either of you expect it to be purely muscular consider going to a doctor of sports medicine and a good chiro. Of the doctors I went to see, they were the first to hone in on the muscular side. Everything I did to make it better is pretty much listed above. After enough time passed, things sort of leveled out and now I just deal and don't think of it much.

Hopefully you two will notice that the pain goes away completely. My 'lump' feeling is most certainly due to the fact that the muscle itself was torn and is now in a different physical position than it was before. The neck is sensitive enough to feel even a slight displacement.
 

skydivinryan

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I'm in the same boat as all of you. 2 months now.. How did all of you guys' symptoms start? Mine came after a serious bout with vomiting and dry heaves.. I think it is muscular, because I've see an ENT, general practice doc, and gastroenterologist. The gastro doc put a scope down my throat but did not see anything.

My general practice doctor said he though I may have strained the muscles in/around my esophagus, and said it should hopefully go away in another couple of months.

Have you all noticed anything else that exacerbates symptoms? For example, whenever I drink alcohol my symptoms are far worse the next day. It also has made running fairily unenjoyable.

How did all of you end up with these problems, and what makes it worse for you?
 

P-funk

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I'm in the same boat as all of you. 2 months now.. How did all of you guys' symptoms start? Mine came after a serious bout with vomiting and dry heaves.. I think it is muscular, because I've see an ENT, general practice doc, and gastroenterologist. The gastro doc put a scope down my throat but did not see anything.

My general practice doctor said he though I may have strained the muscles in/around my esophagus, and said it should hopefully go away in another couple of months.

Have you all noticed anything else that exacerbates symptoms? For example, whenever I drink alcohol my symptoms are far worse the next day. It also has made running fairily unenjoyable.

How did all of you end up with these problems, and what makes it worse for you?


I will prefice what I am about to say with the fact that Doctors know pretty much nothing about soft tissue injuries. The fact that the doctor told you it should "hopefully go away in a few months" confirms this.

Find a massage therapist or a very good manual phyiscal therapist that can work on your tissue. Someone who understands neuromuscular release and trigger points would be very helpful to you.

As well, you may want to try to find a physical therapist that is knowledgeable about primal reflex release technique (prrt) as it may be able to help you inhibit the hypertonic muscles that using a reflex response from the body.
 

Biggly

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Awesome thread - and I hope things go well for all concerned!

The neck is a damn sensitive area. I "cricked" my neck once just looking over my shoulder to reverse a truck after driving on a cold day with the window open - that was about 6 years ago and still sometimes get pain in it after sleeping heavily. Those kind of little injuries are hard to treat but even harder to ignore.

Just want to say ice pack to the neck - very bad idea. If you cool one side more than the other you can cause further problems, if you cool the brain's blood input side you can knock yourself unconcious - or worse.

+2 for accupuncture, just make sure it's a specialist, not a hobbyist.


B.
 

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I hope people will read this!

Cardinal and co, i too have been suffering from a neck pain that seems to be in the same place as you described. I played the trumpet up until a year and a half ago when i developed a pain in that area.....after being concerened that it wouldnt go away, ive been to doctors and specialists who cant seem to help. at one point they thought that acid reflux could be irritating the throat as it causes a gag reflex that involves neck muscles; and hence stopping muscles relaxing/healing. I am still unsure as to weather this may or may not be the cause. perhaps it may be worth you guys having that checked out too?? sometimes you cant feel reflux so you dont realise you have it. Other than that i know this is a really old post but am hoping that perhaps YOU have made some progress since your last posts?
i have some questions to see if our 'thing' is the same:

1.does it hurt much more after periods of talking/singing?
2.does it hurt more after alcohol?
3.is the pain more like a kind of tightness/soreness unless aggravated further?
4. does it appear to be worse about 30 mins + after eating, but relived whilst chewing food/eating?

I too tried pain killers/anti imflam tables to no result. This is seriously depressing me now as i have already had to give up playing the trumpet and it affects me greatley in all areas of my life as i cannot talk for extended periods - this affects partys, working in jobs, getting to know ppl etc and its a HUGE cause of concern for me. I am 24 and was set to be a professional musician, but now am looking for another career (that doesnt envlove talking much!)

so pleeease send me and advice if you have any. i reccomend seeing if acid reflux is irritating your condition as i have been told that this can sometimes be the case.

Jon
 

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I've had this same problem since June '08, but it got a lot worse in Sept '08.

I can't weight lift or do uphill running or anything. It sucks and it's annoying!! I went to my main doctor and he doesn't know what it could be, he recommended to get a endoscopy, x rays, and a MRI. But I have no health insurance so that will cost me an arm and a leg.

It's really annoying and I just want to know whats wrong!!!!

oh and to answer johnhickman's questions.

1. Yup
2. For the most part, yes
3. Yup
4. Sometimes

I also have "Acid Reflux", I recently just stopped taking all antacids though cause they don't solve anything, they just mess your digestive track up. I'm trying to get rid of it naturally by not mixing meats and starches, chewing my food better, small meals...etc. Its hard for me to stay on a planned diet though since my days are different and I am not really working out much (which gets me depressed so I tend to eat some junk).
 

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zenblend

I think its better if you have to take a massage therapy it will provide some relief from that try it
 

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wildblue98

John Hickman and Cardinal I find both of your stories very interesting as they remind me a lot of an injury I sustained over a year ago while lifting a heavy incline bench press with bad form and rotating my neck. Since the injury I have had peristent foriegn body sensation at the hyothyroid level in the neck which is the exact level you both describe. I had every test done mri, x rays, saw a dozen specialists in the area and noone could figure out what was wrong with my neck nothing showed up on any of the tests, I was in a lot of pain, and the doctors brushed it off as something muscular because they could not figure it out. My problem has gotten so bad I can not talk more than 5 min a day John Hickman so I sympathize with your problem it is awful. 3 months ago though I saw an ENT in Los Angeles and came across an article on clicking in the throat in which patients had persistent foriegn body sensation at the level in the neck you both describe caused by the elongation of the superior cornu of the thyroid cartilage. This flexible cartligenous fiber is very prone to become bent or stretched out from neck injuries it is in fact anatomically the weakest structure in the neck that is beneath the muscles. I noticed a slight click when I was pushing in on the area above "where you take your pulse" one day and I could replicate this click every time I pushed in softly. I decided to get this larnygeal crepitus checked out by the ENT who ordered a 3D axial CT SCAN which is the best imaging test avaliable to view this flexible cartilage. What they found is that I had elongated both portions of the cartilage so that they were comming into close contact rubbing on my transverse process. The elongation of the superior cornu thryroid cartilage also creates persistent foriegn body sensation at that level by putting pressure on the hypopharynx. What you guys describe is very similar to mine so I would really give this test a shot to see if you have a similar abnormality. Also, John Hickman I read one medical article on a man who was a trumpet player and had terrible pains from playing the trumpet in the area you described. It turned out it was something wrong with his superior cornu thryroid cartilage and this area was excised and the man was symptom free and did not have problems talking or blowing his trumpet again, so I would really look into this. I thought I had exhausted every possible test and then finally when I was going to give up they found the structure that had been altered from the injury, pain is not imaginary and there is obviously somethign wrong with both of your necks, it may very well be your thyroid cartilage which has been elongated or bent and this is the only thing you guys have not ruled out in that area so I would look into it.
 

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Hi - I know this post is very OLD. BUT, I feel a bit desperate here after car accident injury to neck and thought I'd try... I am in LA and would love to see the doctor you saw. Can you please tell me who it was? I can go where ever and am close to UCLA. Am dealing with exact symptoms as first described and have been ruling out different things ever since car accident almost a year ago. GOAL is to get back to my life of sport and exercise, but right now running aggravates neck, jaw, face, headache... nausea - fun stuff. Been seeing amazing PT for TMJ disorder sypmtoms, but have not seen specialist for neck. Just saw Orthopedic Surgeon who seems a bit far from the muscle investigation... he is going to have me do a "flexion" and "extension MRI" because other MRI and X-ray of neck and CT of head showed only a small bulge at c5 and Doctors think that's not the cause of persistent neck pain.

I'd love any help or ENT/Hyoid bone syndrome type specialists... in Los Angeles? THANKS!!!
 
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