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PART 3: HE's BACK: A Patient With Parkinsonian Tremor?

Published about 14 hours ago • 1 min read

Hi, here's the Part 3 follow-up to the patient with Parkinsonian tremor who has returned with vertigo-like symptoms.

RECAP:

72-year-old male with a 9-month history of "Parkinsonian tremor" right-sided that responded to cervical spine mechanical repeated movements and remained better. He then returned a few months later with vertigo-like symptoms. Sustained retraction and sustained upper TH extension supine over #1 soccer ball improved multiple baselines.

MRI Results

Disc space heights: Preserved

C1-2: Unremarkable.

C2-3: No significant disc herniation, foraminal stenosis or spinal canal stenosis.

C3-4: Mild disc bulge. Right uncovertebral degenerative changes. Moderate bilateral facet arthropathy. Moderate left foraminal stenosis. Severe right foraminal stenosis. No central canal stenosis.

C4-5: No disc herniation. Severe right facet arthropathy and mild left facet arthropathy. Moderate left foraminal stenosis. Severe right foraminal stenosis. No central canal stenosis.

C5-6: Mild disc bulge. Moderate bilateral facet arthropathy. Moderate-severe bilateral foraminal stenosis. No central canal stenosis.

C6-7: Mild disc bulge. Severe right and moderate-severe left foraminal stenosis. No central canal stenosis.

C7-T1: No significant disc herniation, foraminal stenosis or spinal canal stenosis.

IMPRESSION:

  • No acute osseous injury of the cervical spine.
  • Cervical spine spondylosis as described above.

FOLLOW-UP:

He has continued to improve with CT extension. Tremor is slight in the R hand with fine motor skills. He demonstrates continued imbalance with standing and walking with negative ataxia.

He had nuclear testing (dopamine transporter scan), and he definitively does not have Parkinsons. He is scheduled for a neurosurgical consult to review his cervical MRI.

His balance improves somewhat with sustained CT extension and postural maintenance, but does not maintain it, partly due to his flexed habitus and loss of postural correction.

EXAM:

Cervical ROM: unchanged from previous

Neuro checks: unchanged from previous

TAKE-AWAY:

A spinal mechanical contribution persists, and he has improved with increased dose of CT extension and general activation. Maintenance is the biggest issue right now. We are dosing his exercise frequently at home and using postural supports. Gravity is relentless. I plan to continue with his current program, incorporating general activation with a postural emphasis and balance work.

Examples of his HEP are below.

Click HERE to sign up for the patient management platform used with this patient, or go to: https://atlashealthx.com/providers/sign_up​

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Until next time,

Ryan Tauzell, PT, Cert. MDT

ryan@atlashealth.io

​atlashealth.io​

Click HERE to sign up ($22/month per clinician), or go to: https://atlashealthx.com/providers/sign_up​

​Click HERE to book a demo with Jason Ward or me and see how we use it.

P.O. Box 11195, Blacksburg, VA 24062
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