Neck and Throat Discomfort: A Neurological Perspective

There is something unusual about the head and neck junction?

Two months ago, after work, I went swimming and then worked the night shift.
I started feeling a tightness in my left chest.
I visited a family medicine doctor who tested my CPK levels, which were over 3000.
The doctor diagnosed me with muscle inflammation and prescribed muscle relaxants and anti-inflammatory pain medication.
Later, I noticed that the tight and aching sensation gradually moved upward from my left upper arm to my neck, and the pressure on my neck made me feel nauseous.
I consulted with a neurosurgeon and a gastroenterologist, and I also went to the emergency room.
I had chest and neck X-rays (left anterior and right), an electrocardiogram, and an endoscopy, all of which showed no issues.
Eventually, the original tightness and discomfort disappeared, but I developed a sensation of a foreign body in my throat, primarily above and below the Adam's apple, with a feeling of tightness that sometimes shifted to the left.
I initially thought it was a neuromuscular disorder.
After much effort, I managed to see a neurologist at Linkou Chang Gung Memorial Hospital, who attributed it to anxiety and prescribed some anxiolytics.
I have a history of allergies that often lead to post-nasal drip and throat pain.
I subsequently visited three ENT clinics; the first one prescribed muscle relaxants and anti-inflammatory medications again, while the latter two prescribed different antibiotics and medications to reduce nasal mucus.
My condition improved significantly.
Now, I only have a dry, sticky sensation above the Adam's apple, as if something is stuck there, without the previous tightness that made me feel nauseous when moving my neck.
Strangely, now whenever I tilt my head up or turn it side to side, I feel a prickly tightness at the junction of my head and neck, as if something is lodged there.
However, pressing or touching it does not cause pain, nor can I feel anything unusual; it just feels more sensitive, and it seems to radiate into my throat.
Previously, I felt the same sensation when touching the area below my left ear, but now it remains in the back of my neck.
I can no longer distinguish whether this is chronic pharyngitis affecting the peripheral nerves and muscles or if it is an underlying neuromuscular issue.
Dr.
Yeh, what should I do? Thank you.

Mr. Huang, 20~29 year old female. Ask Date: 2005/09/21

Dr. Ye Boshou reply Neurology

It is difficult to distinguish whether it is a peripheral nerve or tension issue.
It is advisable to have a single neurologist monitor the case for better differentiation.

Reply Date: 2005/09/21

More Info

Understanding neck and throat discomfort from a neurological perspective can be quite complex, especially when symptoms overlap with various bodily systems. Your experience of discomfort beginning after swimming and subsequently escalating to sensations in the chest, arm, neck, and throat suggests a multifaceted issue that may involve muscular, neurological, and possibly psychological components.

Initially, the symptoms you described, such as the tightness and discomfort in the left chest and arm, could be attributed to muscle strain or inflammation, particularly if you engaged in physical activity like swimming followed by a night shift. Elevated CPK levels often indicate muscle injury or inflammation, which aligns with the treatment you received, including muscle relaxants and anti-inflammatory medications. However, as the discomfort migrated to your neck and throat, it raises the question of whether there might be additional factors at play.

The sensation of tightness or a foreign body feeling in the throat, often referred to as "globus sensation," can be influenced by several factors, including anxiety, muscle tension, or even gastroesophageal reflux disease (GERD). Given your history of allergies and nasal issues, it’s also possible that post-nasal drip could contribute to throat irritation, leading to discomfort. The fact that your symptoms improved with certain medications suggests that inflammation or muscle tension may have played a significant role.

From a neurological standpoint, the neck and throat are innervated by various cranial and cervical nerves. Tension in the neck muscles can lead to nerve irritation or compression, which may manifest as discomfort or altered sensations in the throat. The tightness you feel when turning your head could indicate muscle strain or tension affecting the cervical spine and its associated nerves. This is particularly relevant if you have a history of muscle tension or anxiety, as stress can exacerbate muscle tightness and lead to a cycle of discomfort.

Your experience of feeling a tightness that radiates to the throat when moving your head could also suggest a neuromuscular component. Conditions such as cervical radiculopathy, where a nerve in the neck is compressed or irritated, can lead to referred sensations in the throat area. Although imaging studies like X-rays and CT scans may not show significant abnormalities, they do not always capture subtle neuromuscular issues.

Given the complexity of your symptoms and their persistence, it would be advisable to consider a multidisciplinary approach. Here are some steps you might take:
1. Follow-Up with a Neurologist: Since you have already seen a neurologist, it may be beneficial to revisit them, especially if your symptoms have changed or worsened. They may recommend further diagnostic tests, such as an MRI, to evaluate for any underlying neurological issues.

2. Physical Therapy: Engaging in physical therapy could help address muscle tension and improve neck mobility. A physical therapist can provide exercises tailored to your needs, focusing on strengthening and stretching the neck and shoulder muscles.

3. Psychological Support: If anxiety or stress is contributing to your symptoms, consider speaking with a mental health professional. Techniques such as cognitive-behavioral therapy (CBT) or mindfulness can be effective in managing anxiety and its physical manifestations.

4. Ear, Nose, and Throat (ENT) Specialist: Since you have seen multiple ENT specialists, it may be worth revisiting one for a comprehensive evaluation of your throat symptoms, especially if you suspect allergies or reflux may be contributing.

5. Lifestyle Modifications: Pay attention to your posture, especially if you work long hours or have a sedentary lifestyle. Ergonomic adjustments and regular breaks can help alleviate muscle tension.

In conclusion, your symptoms appear to be multifactorial, involving muscular, neurological, and possibly psychological components. A comprehensive approach that includes medical evaluation, physical therapy, and psychological support may provide the best pathway to relief. It’s important to communicate openly with your healthcare providers about your symptoms and any changes you experience to ensure a thorough evaluation and appropriate management.

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