Head drop syndrome

[paingate21]

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Any one have suggestions for pain relief in head drop syndrome? Pain is in the cervical paraspinals from the postural change.

Has seen Neuro (had EMG) and Spine Surgery (not interested in extensive fusion). MRI cervical spine without major stenosis.

Been wearing a soft collar for comfort. Have done some LA only TPIs.

 

[BobBarker]

Reactiv8 maybe? Seems like the best use of this device I can think of.

 

[cowboydoc]

Reactiv8 maybe? Seems like the best use of this device I can think of.

Haven’t seen this anywhere but L3, but interesting thought.

 

[Dansk2011]

I have a lady referred by neurology for botox that I inject her anterior neck muscles (scalenes, scm, and longus) which has helped a lot. Obviously not corrective but seems to help her posture and put less stress on her posterior neck.

 

[SSdoc33]

hard collar

 

[BoardingDoc]

Halo

 

[paindoc007]

Halo

Had a legitimate lol from this

 

[paingate21]

For Botox - what diagnosis do you use to get coverage? Dystonia?

 

[nvrsumr]

Just saw had a patient this week. Referred for Botox

Have med student this month and felt like a poser punting.

too much hassle for an us guided tp with $500 med cost.

 

[BoardingDoc]

Just saw had a patient this week. Referred for Botox

Have med student this month and felt like a poser punting.

too much hassle for an us guided tp with $500 med cost.

What?
1: Why are you using US?
2: It doesn't reimburse as a TP. It reimburses as 64616. It doesn't pay a lot, but still about triple what a TP does.
3: The patient/insurance handles the med cost, not you. If you have to do the PA yourself, it can certainly be annoying as I had to do them all the time during fellowship, though honestly it's very easy for cervical dystonia. Migraine was more of a pain in the ass to get auth.

 

[MitchLevi]

Soft collar

 

[Dansk2011]

What?
1: Why are you using US?
2: It doesn't reimburse as a TP. It reimburses as 64616. It doesn't pay a lot, but still about triple what a TP does.
3: The patient/insurance handles the med cost, not you. If you have to do the PA yourself, it can certainly be annoying as I had to do them all the time during fellowship, though honestly it's very easy for cervical dystonia. Migraine was more of a pain in the ass to get auth.

Depending on what you plan to inject I'd definitely us ultrasound. I'd never attempt a blind longus colli injection with all the vasculature in the area. Done enough of these and stellates with ultrasound. Not worth the risk.

 

[bedrock]

What?
1: Why are you using US?
2: It doesn't reimburse as a TP. It reimburses as 64616. It doesn't pay a lot, but still about triple what a TP does.
3: The patient/insurance handles the med cost, not you. If you have to do the PA yourself, it can certainly be annoying as I had to do them all the time during fellowship, though honestly it's very easy for cervical dystonia. Migraine was more of a pain in the ass to get auth.

Agree with the 64616 and that the patient gets a script for Botox and picks up the script so no chance you get burned on the Botox cost.

That said, even 64616 pays crap for time involved. I do Botox regularly for only one patient, a wife of a local physician.

 

[BoardingDoc]

Agree with the 64616 and that the patient gets a script for Botox and picks up the script so no chance you get burned on the Botox cost.

That said, even 64616 pays crap for time involved. I do Botox regularly for only one patient, a wife of a local physician.

Yeah, if you have a busy practice and don't have any open injection slots, I certainly wouldn't fill them with Botox. It isn't a bad recurring revenue stream that you can turn an office visit into though on your non-flouro days.

 

[JBM16BYU]

Rarely have I seen head drop syndrome from muscle weakness (not structural like kyphosis) that wasn’t caused from either an axial myopathy, motor neuron disease, or disorder of the NMJ. Or, unfortunately, iatrogenic from too many botulinum toxin injections to the cervical paraspinal, trapezius, and sub occipital musculature. For the former, referral to neuromuscular for underlying diagnosis is important, particularly for NMJ disorders for immunosuppressant optimization. For myopathies and MND, I’ve had good success with the headmaster or aspen vista collars, both to reduce strain on the neck but also to allow the individual to look up and be “present” instead of having to look at their feet.

 

[Snowmen96]

Rarely have I seen head drop syndrome from muscle weakness (not structural like kyphosis) that wasn’t caused from either an axial myopathy, motor neuron disease, or disorder of the NMJ. Or, unfortunately, iatrogenic from too many botulinum toxin injections to the cervical paraspinal, trapezius, and sub occipital musculature. For the former, referral to neuromuscular for underlying diagnosis is important, particularly for NMJ disorders for immunosuppressant optimization. For myopathies and MND, I’ve had good success with the headmaster or aspen vista collars, both to reduce strain on the neck but also to allow the individual to look up and be “present” instead of having to look at their feet.

I agree with the Headmaster. Much more supportive and effective than a soft collar.