Kopfschmerz, Schwindel, Tinnitus und Halswirbelsäule

[Atlas block and alar ligament lesion-Underestimated or overrated?]

BACKGROUND

Disorders of the upper cervical spine, most notably lesions of the alar ligament and atlas block, are associated with numerous symptoms, especially as reported in the lay press. Thus, physicians are often confronted with patients who see in them a monocausal origin of complex complaints and hope for a quick remedy.

OBJECTIVE

This review article presents the currently available evidence-based literature on atlas block and alar ligament lesions in order to adequately appreciate their significance.

MATERIAL AND METHODS

Summary and critical evaluation of an extensive review of the literature on the diagnostics, clinical presentation, and treatment of disorders of the upper cervical spine.

RESULTS

The current literature shows that alar ligament lesions are caused only by extremely high-speed trauma and that the reliability of their detection on magnetic resonance imaging (MRI) is moderate at best. As several studies have failed to demonstrate a correlation between symptoms and abnormalities of the alar ligaments on MRI, surgical stabilization of the upper cervical joints is not indicated. The diversity of symptoms associated with atlas block may be explained by the convergence of afferent neurons originating in C1-C3 on several cranial nerve nuclei found in neuroanatomical studies, but this association has yet to be proven. First studies show that highly significant improvements in cervical pain and range of motion can be achieved by means of manual therapy of the upper cervical spine with lasting effects even after 6 months.

CONCLUSION

The importance of alar ligament lesions has often been overrated in the past; however, a more nuanced multifactorial understanding of the disorder should be conveyed to the patient. An atlas block should be considered mainly as a possible cause of pain and restricted range of motion of the cervical spine and in this context manual therapy can be an effective treatment option.

[Pilot study: evaluation of manual methods for modulating the cardinal symptom tinnitus : A prospective randomized study]

Hintergrund

Tinnitus und Schwindel wurden schon auf vielfältige Weise untersucht. Daraus ergaben sich multiple Erklärungsansätze aus verschiedenen medizinischen Disziplinen. Auch die Muskulatur des Kiefers und der Halswirbelsäule wurde diesbezüglich erforscht. Es zeigten sich deutliche Hinweise dafür, dass bei Funktionsstörungen dieser Muskulatur Tinnitus ausgelöst werden kann. Diese Unterart des Tinnitus wird als sog. zervikogener somatosensorischer Tinnitus bezeichnet.

Ziel der Studie

Das Ziel war die Untersuchung des Effekts der manuellen Therapie auf die von Probanden berichtete, individuell empfundene Beeinträchtigung durch zervikogenen somatosensorischen Tinnitus (Tinnitus Handicap Inventory), auf die Schwindelsymptomatik (Dizziness Handicap Inventory) und auf die hypertone zervikokraniale Muskulatur.

Methodik

In einer prospektiven randomisierten Studie wurden 80 Patient*innen (40 in der Interventionsgruppe und 40 in der Kontrollgruppe) ärztlich untersucht und befragt. Anschließend erhielten sie manuelle Therapie.

Ergebnisse

Nach manueller Therapie zeigten sich bzgl. des Tinnitus Handicap Inventory, des Dizziness Handicap Inventory und muskulärer Hypertonien signifikante Unterschiede zwischen den Gruppen zugunsten der Interventionsgruppe.

Schlussfolgerung

Die manuelle Untersuchung und Therapie stellten sich als wirksam heraus. Sie sollte bei ausbleibender HNO-ärztlicher Organpathologie und Verdacht auf zervikogenen somatosensorischen Tinnitus verstärkt zur Anwendung kommen. Die Rolle der einzelnen Muskeln gilt es tiefergehend zu untersuchen.

[Somatic dysfunction of the cervical spine and its complex clinical picture : The fundamentals of diagnostics of cervicobrachialgia and cervicocephalic syndrome through manual medicine]

Patients suffering from a segmental and somatic dysfunction of the cervical spine often present a wide variety of clinical symptoms related to cervicobrachial or cervicocephalic syndrome. These symptoms might evolve out of complex neural intersegmental or trigeminocervical interactions in the brain stem or the spinal cord of the cervical spine. After the exclusion of life-threatening preconditions, a careful physical examination with aspects of manual medicine aspects might unmask the cervical dysfunction as the primary cause of the symptoms. Treatment with manual medicine on the basis of a segmental antinociceptive proprioceptive input might then be an appropriate therapeutic approach.