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Mourad F, Milella C, Lullo G, Zangari F, Meroni R, Taylor A, Kerry R, Hutting N, Maselli F. Recognition of Prodromal Hypoglossal Nerve Palsy Presenting with Neck Pain as Primary Complaint: Findings from a Rare Case Report in Direct Access Physiotherapy during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:healthcare11091342. [PMID: 37174884 PMCID: PMC10178515 DOI: 10.3390/healthcare11091342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
Neck pain (NP) is the second most common musculoskeletal disorder. Spinal cysts (SCs) are cystic dilatations of the synovial sheaths in joints and tendons. SCs are extremely rare in the cervical spine. Typically, patients are unaware of having an SC due to its asymptomatic nature; however, when cervical SC extends, its volume could compress the surrounding structures, such as the hypoglossal nerve. Isolated hypoglossal nerve palsy (HNP) is very rare and typically presents with unilateral atrophy of the musculature of the tongue and contralateral tongue deviation. Often, patients with HNP also report occipital/neck pain. A 75-year-old man with occipital/neck pain as a primary complaint. Although difficult to observe because of the filtering facepiece two mask, difficulties in articulation and sialorrhea during the interview were noticed. These latter were cues to consider CN examination that revealed CN XII palsy. This prompted a referral for further examination that revealed an SC compressing the right hypoglossal canal. The patient was not considered a surgical candidate and was managed conservatively. This case report outlines the relevant findings relating to the triage of a rare isolated hypoglossal nerve palsy from the physiotherapist's perspective within a complex setting because of the COVID-19 pandemic. Although referred with a diagnosis of cervical radiculopathy, our case highlights that skilled physiotherapists may play a fundamental role in both the recognition and, when applicable, subsequent novel management of a non-musculoskeletal presentation.
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Affiliation(s)
- Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg
| | - Claudia Milella
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Graziana Lullo
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Francesco Zangari
- Radiology Service, Azienda Socio Sanitaria Territoriale della Franciacorta, Viale Mazzini 4, 25032 Chiari, Italy
| | - Roberto Meroni
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg
| | - Alan Taylor
- Faculty of Medicine and Health Sciences, School of Health Sciences, Division of Physical Therapy and Sport Rehabilitation, University of Nottingham, Nottingham NG5 1PB, UK
| | - Roger Kerry
- Faculty of Medicine and Health Sciences, School of Health Sciences, Division of Physical Therapy and Sport Rehabilitation, University of Nottingham, Nottingham NG5 1PB, UK
| | - Nathan Hutting
- Department of Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, 6503 GL Nijmegen, The Netherlands
| | - Filippo Maselli
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
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