Retropharyngeal Tendinitis and Dysphagia After a Car Crash
This interesting case study illustrates the potential relationship between neck trauma, delayed onset of neck pain, and dysphagia.
"A 42 year old secretary in excellent health fell, in the sitting position, into a stream. She had minor abrasions of the limbs but did not hurt her neck or head. Ten days later she developed a stiff neck. Turning the neck to the left side was painful, making driving difficult. After two days pain increased; prescribed methocarbamol failed to provide relief. On day 3 she had painful difficulty in swallowing, not in the throat but in the right side of the neck 'as if the muscles and ligaments were strained,' and painful movement was relieved when flexing her neck."
The dysphagia increased to the point where the patient could swallow only sips of water. "She held her neck to ease swallowing. She also took to holding her head with both hands to enable her to lay her head on the pillow, and to sit up when getting out of bed." Her symptoms gradually improved, and by day 12 they had resolved.
"The unusual combination of such distinctive symptoms suggests a lesion in the retropharyngeal space involving the prevertebral muscles...The salient features are: (1) The curious location of pain, mainly in the side of the neck. This is quite different from that experienced in common neck sprains of whiplash injury, which are maximal in the posterior neck muscles with radiation to the shoulders, occiput, and interscapular regions. (2) Pain aggravated by movement... (3) Pain is dramatically increased by swallowing. (4) Painful dysphagia is felt not in the throat, but in the side of the neck. Patients may be obliged to hold their necks to allow swallowing. (5) The illness is unaccompanied by fever or systemic disturbance and is self-limiting."
The author attributes the symptoms to damage of the longus cervicis colli.
Pearce JMS. Longus cervicis colli "myositis" (syn: retropharyngeal tendinitis). Journal of Neurology, Neurosurgery, and Psychiatry 1996;61:324.