Posttraumatic Focal Dystonia of the Shoulder

Höllinger, Peter; Burgunder, Jean‐Marc

doi:10.1159/000008225

Cited by 16 publications

(10 citation statements)

References 13 publications

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“…Apart from these patients, however, there are others who comprise a clinically distinct form of posttraumatic dystonia. These patients, including those designated as having posttraumatic cervical dystonia (PTCD),17–23 typically develop the problem after minor local injury and have features that are clinically quite different from idiopathic forms of dystonia. These features include relatively sudden onset, rapid progression to maximum severity, tonic, persistent fixed dystonia at rest, prominent pain, stereotypic course and poor response to therapy.…”

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confidence: 99%

Posttraumatic painful torticollis

et al. 2003

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The development of abnormal posturing of the neck or shoulder after local injury has been termed posttraumatic cervical dystonia (PTCD). Certain features seem to distinguish a unique subgroup of patients with this disorder from those with features more akin to typical idiopathic cervical dystonia, such as onset and maximum disability that occurs very quickly after injury, severe pain and a fixed abnormal posture. In an attempt to clarify the nature of this syndrome further, we evaluated 16 such patients (8 men, 8 women). Motor vehicle accident and work-related injuries were common precipitants, with posturing usually developing shortly after trauma, and little progression occurring after the first week. A characteristic, painful, fixed head tilt and shoulder elevation were present in all but one patient, who had a painless elevated shoulder and painful contralateral shoulder depression, as well as nondermatomal sensory loss in 14 patients. Additional abnormalities included dystonic posturing in a limb (2 patients) or jaw (1 patient), limb tremor (3 patients) and "give-way" limb weakness (8 patients). The tremor and the jaw dystonia demonstrated features suggestive of a psychogenic movement disorder, most commonly distractibility. Litigation or compensation was present in all 16 patients. Intravenous sodium amytal improved the posture, pain or both in 13 of 13 patients; in 7 of 13 the sensory deficit either markedly improved or normalized. General anesthesia demonstrated full range of motion in all 5 patients assessed. Psychological evaluations suggested that psychological conflict, stress, or both were being expressed via somatic channels in 11 of 12 tested patients. Our results suggest an important role of psychological factors in the etiology or maintenance of abnormal posture, pain and associated disability of these patients. The role of central factors triggered in psychologically vulnerable individuals after physical trauma is discussed. We propose that the disorder be referred to as "posttraumatic painful torticollis" rather than characterize it as a form of dystonia until further information on its pathogenesis is forthcoming.

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Posttraumatic painful torticollis

et al. 2003

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“…Dewey and colleagues 18 and Hollinger and Burgunder 19 reported on isolated cervical and shoulder muscle dystonia in response to peripheral trauma, which may represent a milder form of posttraumatic cervical dystonia. Analogous to posttraumatic cervical dystonia, oromandibular dystonia has been reported to occur after trauma including dental work and orodental surgery.…”

Section: Discussionmentioning

confidence: 99%

Natural history of posttraumatic cervical dystonia

et al. 2004

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The most common form of focal dystonia is torticollis or rotation of the neck to one side. Most cases of torticollis are idiopathic, although some may result from a number of identified causes including brain injury, brain tumor, stroke, cervical cord injury or lesion, drugs including levodopa (L-dopa) and neuroleptics, multiple sclerosis and, in some cases, genetic abnormalities.A small number of patients report a history of trauma before onset of dystonia. Severe head trauma associated with brain injury that produces identifiable lesions, particularly in the putamen, has been known to cause hemidystonia. 1 Peripheral trauma as a precipitating cause of dystonia is not accepted universally, 2-4 although one of the earliest reported cases of torticollis, the Birmingham mummy, is thought to have been caused by an arrow in the neck. 5 Posttraumatic cervical dystonia is thought to be a unique syndrome, distinct from idiopathic torticollis. Some of its unusual features include a limitation in cervical range of motion, fixed posture, absence of "geste antagoniste," persistence of symptoms during sleep, lack of improvement after sleep (the "morning honeymoon" effect), dominant laterocollis, and poor response to botulinum toxin injections. 6,7 Complex regional pain syndrome I (CRPS-I) has been known to occur in posttraumatic cervical dystonia, and dystonia has been seen in CRPS. 8 -10 CRPS-I is defined as a pain syndrome that usually develops after an initiating noxious event, is not limited to the distribution of a single peripheral nerve, and is disproportional to the inciting event. 11 It is associated with edema, changes in blood flow, abnormal sudomotor activity in the region of pain, and allodynia or hyperalgesia. Schott 12 first proposed a possible relationship between peripheral traumainduced movement disorders and causalgia or reflex sympathetic dystrophy in 1986. We describe 9 additional patients, 3 of whom exhibit CRPS, with posttraumatic cervical dystonia after apparent peripheral trauma, who share characteristics unique to the syndrome. PATIENTS AND METHODSPatients with dystonia of the cervical musculature who presented to the Parkinson's and Movement Disorder Clinic in Fountain Valley, CA were systematically asked for history of trauma at their first interview. Inclusion criteria 2 were as follows: (1) months of the trauma; (2) no history of pyramidal, cerebellar, sensory, or intellectual deficits; (3) no history of perinatal encephalopathy or kernicterus; (4) normal childhood developmental milestones; (5) no improvement with L-dopa as seen with dopa-responsive dystonia and no history of paroxysmal dystonia; (6) no abnormality on an imaging study that could be construed as a cause of torticollis; and (7) no significant laboratory abnormalities. Treatment with botulinum toxin was provided according to patient need and patients were followed for up to 5 years. RESULTSOf 892 patients in our database, 9 met the inclusion criteria. They ranged in age from 31 to 56 years and all noted onset of dystonia within ho...

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“…Effective gestes antagonistes are seen less frequently and "overflow" of the dystonia and worsening with action are not seen. Restricted forms of this syndrome limited to a single cervical muscle [8] and focal shoulder dystonia [16,38] have also been described.…”

Section: Introductionmentioning

confidence: 99%

Cervical dystonia following peripheral trauma

O’Riordan

Hutchinson

2004

J Neurol

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Post-traumatic cervical dystonia as a diagnostic entity remains a subject of debate. Patients with cervical dystonia (CD) were asked to identify any significant illness prior to the onset of their CD. Sixteen patients of 95 respondents reported a history of injury in the four-week period prior to onset of their dystonia. A retrospective study of the clinical characteristics of the 16 patients with early post-traumatic CD (CD-PT) in comparison with the 52 patients reporting no antecedent trauma (CD-NT) was performed. In this comparison the CD-PT group had a significantly increased frequency of laterocollis, significantly more reported pain and more reported depression. Non-significant trends were noted for less responsiveness to botulinum toxin and less use of gestes antagonistes in the CD-PT group. There were no group differences in the presence of a family history of dystonia. Eleven of the CD-PT group had been or were currently involved in litigation. A sub-group of seven CD-PT patients had laterocollis, six of whom conformed to a clinical pattern of persistent non-spasmodic laterocollis with marked pain; all seven had been involved in litigation. This form of CD-PT is a distinct clinical entity and has an onset within hours or a few days of the trauma. In contrast, no significant differences were noted between patients with CD-NT and the eight patients with later onset of CD between 4 weeks and one year after peripheral trauma.

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Posttraumatic Focal Dystonia of the Shoulder

Cited by 16 publications

References 13 publications

Posttraumatic painful torticollis

Posttraumatic painful torticollis

Natural history of posttraumatic cervical dystonia

Cervical dystonia following peripheral trauma

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