Dizzy patient

Musculo outpatients:

Week 2, I was presented with a young lady in her 20’s who said the world was swaying and she felt unsteady on her feet – this had been the case for the last 2 weeks. Being a scientist herself she had been mapping the symptoms but could not find a pattern at all, it could last for 30-60 min or more with no known aggravating factors. Sometimes when she was walking, sitting, standing, it was not relieved by lying down or being still. The patient had continued to play netball and volleyball and when dizziness came on she continued. After a couple of episodes where she felt she was going to fall over and then not falling, she now continues to walk, or play believing she will not actually fall.

She had been to see a Dr who said it wasn’t anything in her inner ear and was most likely the muscles in her neck – one side tighter than the other giving different proprioceptive feedback to the brain so one side indicates movement and the other not – the confused brain suggests the ground or the person is swaying!

On hearing all this I thought I would check her vestibular system and vertebral artery in addition to a Cx objective and go on from there. All were negative, I couldn’t make the already present mild symptoms worse or better.

AROM – ↓ lateral flexion R>L, flexion and a slight decrease in rotation. Pt reports always had a ↓ in flexion, has AS however managed well and in remission at present.

PPIVMS – nothing unusual, PAIVMS – tender C3 mainly also C2 and C4 centrally and R uni-laterals.

Palpation – tight upper traps, LS, scalenes, occipital insertion – nuchal line.

With such marked muscle tightness I treated with STM for 10-15 min in hope to reduce some of the tension and see if symptoms changed. When I had finished and the patient sat up from prone she felt much worse so suggested the chair with back and arms so she could hang on. After 5 min the symptoms had returned to pre Rx levels. The AROM had improved and the patient reported feeling much better – even though symptoms still present! Supervisor said the symptoms may get worse before getting better.

I am eager to see my patient tomorrow to see if my Rx had a good, bad or no effect on her symptoms.

I was not aware that tight musculature in the Cx region could make someone dizzy, my supervisor says it is possible so we will see if in this case it is true or otherwise have to refer back to the Dr for further investigation.