Dropped Head Syndrome
Constantly gazing at your mobile phone may develop severe strain on muscles of the back of neck that can cause Dropped Head Syndrome which can be a serious condition.
Recently a news has gained momentum regarding a 25-year-old Japanese man who frequently looked down at his phone also spending hours playing games for extended periods eventually lost the ability to lift his head and was diagnosed with Dropped Head Syndrome.
Another case reported, which has also gone viral wherein a 23-year-old man from Iran suffered from extreme bend in his neck, which developed after years of substance abuse.
The drugs caused significant rounding of the spine until the neck could no longer support the head.
Doctors say the syndrome could be caused by substance abuse.
The medics reported that use of amphetamine (also known as speed) triggered what they called a fixed kyphotic neck position, where his chin fell to his chest for long periods.
He also experienced chronic neck pain and paresthesia the feeling of tingling, numbness, pins and needles in his arms. While the patient had no history of severe neck trauma that could explain his symptoms, he had a history of depression and use of amphetamines, opium and heroin.
Introduction:
Dropped Head Syndrome is characterized by severe weakness of the muscles of the back of the neck. This causes the chin to rest on the chest in standing or sitting position. Floppy Head Syndrome and Head Ptosis are other names used to describe the syndrome.
Dropped head syndrome is also called the chin on chest deformity. It is a very rare condition that occurs when the back and neck muscles become too weak to hold up the head and it rests on the chest.
Most of the time, Dropped Head Syndrome is caused by a specific generalized neuromuscular diagnosis.
Causes:
Dropped Head Syndrome is caused by a specific generalized neuromuscular diagnosis. These include amyotrophic lateral sclerosis (ALS) also known as Lou Gehrig’s disease, Parkinson’s disease, myasthenia gravis, polymyositis, and genetic myopathies. Other specific causes can include motor neuron disease, hypothyroidism, disorders of the spine, and cancer.
When the cause of Dropped Head Syndrome is not known, it is called isolated neck extensor myopathy, or INEM.
The INEM form of Dropped Head Syndrome usually happens in older persons. The weakness of the muscles in the back of the neck usually occurs gradually over one week to three months.
Symptoms:
The symptoms of dropped head syndrome are usually painless. It most often occurs in the elderly. The weakness is limited to the muscles that extend the neck. Dropped Head Syndrome usually develops over a period of one week to three months. The head is then tilted downward. Because of the weakness of the extensors of the neck, the chin rests on the chest. Lifting or raising the head in sitting or standing is impossible. When lying down however, the neck is able to extend.
Gaze is down at the floor, instead of forward. The face is downward. The neck appears elongated, and the curve at the base of the neck is accentuated. This can cause over stretching or pinching of the spinal cord. When this happens, there may be weakness and numbness of the arms or entire body.
Dropped head syndrome can also cause difficulty swallowing, speaking, and breathing.
Diagnosis:
Diagnosis begins with a complete history and physical exam. Your doctor will ask questions about your symptoms and how your problem is affecting your daily activities.
Physical examination to test your reflexes, skin sensation, muscle strength.
Most of the time, loss of of neck extension occurs as part of a more generalized neurological disorder. Neurological conditions must be considered first because some are treatable. A neurologist will usually be involved to help decide what is causing the chin-on-chest deformity.
Doctors advise for magnetic resonance imaging (MRI) of neck. It shows the anatomy of the neck. It is very good at showing the spinal cord and nerves.
Electromyography (EMG) uses small diameter needles in the muscle belly being tested. It helps determine how well the nerve conducts signals to the muscles.
A muscle biopsy may be needed. A small piece of muscle is removed and examined under a microscope. A closer look at the muscle fibers can be helpful in making a diagnosis.
In isolated neck extensor myopathy (INEM), the muscle biopsy is non-specific. EMG shows some myopathic changes.
Some doctors feel that isolated neck extensor myopathy (INEM) is caused by either a non-specific non-inflammatory or inflammatory response that is restricted to the neck extensor muscles. Another possible cause is thoracic kyphosis. When the natural curve of the thoracic spine is increased, it may place the extensor muscles at a disadvantage given the weight of the head. This may cause over stretching and weakness of the extensor muscles.
Treatment:
Isolated neck extensor myopathy (INEM) is considered benign because it does not spread or get worse. It is most often treated conservatively.
Nonsurgical Treatment:
Treatment of Dropped Head Syndrome is mainly supportive. The weakness remains localized to the neck extensor muscles; physical therapy may help with this. There are some cases that improve dramatically, but most usually do not improve.
The most useful treatment is use of a neck collar. It can partially correct the chin-on-chest deformity. This improves the forward gaze and activities of daily living. It also can help prevent contractures of the neck in a fixed flexed posture. However, it can be uncomfortable and cause sores under the chin. Some use a baseball cap attached to straps around the trunk. This avoids the chin discomfort from using a collar.
Prednisone is a potent anti-inflammatory that may be prescribed. It may be beneficial when there is local myositis, or inflammation of the muscles. It can be taken in a pill form by mouth or intravenously.
Surgery:
Unless fusion is necessary, surgery is usually not recommended in Dropped Head Syndrome.
When there is damage to the nerves in the neck or spinal cord, surgery to fuse the neck may be necessary. This usually requires a fusion from C2-T2. The loss of neck movement after fusion leaves patients unable to see the ground in front of their feet. This makes them at greater risk for falls. The inconvenience caused by having a rigid neck may prove to be a greater problem than the original dropped head deformity.
Osteoporosis, particularly in older females also poses a problem with surgery. The soft bone may allow the metal used to stabilize the spine to pull out.
Rehabilitation:
Nonsurgical Rehabilitation
Physical therapy is usually recommended. Neck extension strengthening exercises may provide some improvement. However, most patients will find the strengthening both tiring and frustrating. When lying down on your back you can move the neck to maintain range of motion. This helps to avoid unnecessary stiffness and shortening of the muscles in the front of the neck.
Range of motion exercises should be done on an ongoing basis to avoid contractures of the neck. Wearing a neck collar when up will likely improve activities of daily living.
Speech therapy may be recommended for swallowing, feeding, and breathing problems. Some people may need to have a feeding tube inserted through the stomach.
Your doctor may want to repeat imaging of the spine. There is the possibility of over stretching or pinching the spinal cord when the neck extensors are so weak. You will need to watch for symptoms such as weakness or numbness in the arms or other portions of the body. Bowel and bladder function could become a problem.
After Surgery:
If surgery is recommended, you will probably require an overnight hospital stay or a few days stay. Initially, you will not be allowed to lift, and you will have to move carefully. Most likely your neck will be placed in a fairly rigid brace. You will eventually be able to resume your normal activities. You can expect healing of the fusion in three to nine months.
Physical therapy is usually recommended after surgery. Neck extension strengthening exercises are prescribed to prevent contracture of the neck. Occupational therapy may be recommended to help with arm strengthening. It can also help with dressing, and other activities of daily living. Equipment needs can be evaluated by the occupational therapist. Speech therapy may also be recommended after surgery.