Objective: To improve pain and quality of life in cervical dystonia (CD) with comorbid generalized joint hypermobility (GJH) using prolotherapy with osteopathic manipulative medicine (OMM).

Background: Management of CD with GJH is not well defined. CD frequently leads to pain and limited range and lack of control in upper body movements. GJH results from connective tissue weakness and may include skin, cardiovascular, and neurological manifestations. Previous studies found pain and other symptoms of hypermobile joints improved with prolotherapy injections with or without manual manipulation.

Method: A 53 year old male with history of CD and GJH complained of twisting, speech and swallow difficulties, mild voice change, insomnia, and neck and back stiffness and pain rated 5/10 for 11 years despite improvements from botulinum toxin injections. Prior imaging revealed 2 small white matter foci in periventricular and left periinsular regions; cervical spine had mild central canal stenosis at C4-5, mild multilevel osteoarthritis, anterior disc bulge, and bilateral foraminal stenosis; mild lumbar dextroscoliosis (apex-L3). Physical exam was remarkable for moderate right torticollis with position-dependent, coarse head and bilateral upper extremity tremor as well as GJH with enthesopathy and tenosynovitis in multiple joints. Osteopathic somatic dysfunctions were present in all body regions. A hypogastric plexus block was performed. Prolotherapy injections were applied to tendonous enthesopathies of the trapezius muscle as well as enthesopathies of the stylomandibular, right low back, knee, and C7-T2 and T7-9 interspinous ligaments. Osteopathic manual treatments were applied to somatic dysfunctions in 8 body regions. The patient tolerated these procedures in each of 3 visits without complications. Post-injection care and precautions were reviewed.

Results: Patient reported much less intense head-turning at night allowing him to fall asleep faster and stay asleep longer. Stiffness, pulling, tingling, and pain greatly improved. He no longer needed gabapentin and nabumetone for pain.

Conclusion: Pain and symptoms of dystonia in a case of CD with tremor and comorbid GJH improved after 3 treatments over 3 months with prolotherapy injections and OMM to improve joint stability, alignment and range of motion. Further treatment research is necessary.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pain-and-symptom-management-in-a-case-of-cervical-dystonia-with-comorbid-generalized-joint-hypermobility-using-prolotherapy-with-osteopathic-manipulative-medicine/