Case Report / Kasuistik

Complement Med Res 2021;28:379–380 Received: August 5, 2020

Accepted: November 17, 2020
DOI: 10.1159/000513131 Published online: January 11, 2021

Sacroiliac Joint Dysfunction Treated Using Neural

Therapy to the Temporomandibular Joint: A Case
Report
Huma Boluk Senlikci Selin Ozen
Başkent University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankara, Turkey

Keywords Behandlung der Dysfunktion des

Temporomandibular disorder · Sacroiliac joint dysfunction · Iliosakralgelenks durch Neuraltherapie des
Local anesthesia · Neural therapy of Huneke · Huneke Temporomandibulargelenks: Ein Fallbericht
neural therapy

Schlüsselwörter
Abstract Temporomandibuläre Dysfunktion · Iliosakrale
Temporomandibular joint disorders (TMJD) include tem- Dysfunktion · Lokalanästhesie · Neuraltherapie nach
poromandibular joint dysfunction and bruxism. Sacroiliac Huneke · Huneke-Neuraltherapie
joint dysfunction (SJD) is a frequent cause of non-discogenic
low back pain. Studies suggest a relationship between TMJD
and SJD; however, the link remains unclear. Neural therapy Zusammenfassung
(NT) utilises local anaesthetic injections to treat pain by nor- Zu den Erkrankungen des Temporomandibulargelenks
malising a dysfunctional autonomic nervous system held re- (TMG) zählen Kiefergelenksdysfunktion und Bruxismus.
sponsible for initiating or propagating chronic pain. A Eine Dysfunktion des Iliosakralgelenks (ISG) ist eine häu-
31-year-old female presented with a 1-year history of me- fige Ursache für nicht von den Bandscheiben ausgehende
chanical left-sided low back pain and sleep bruxism. Exami- Kreuzschmerzen. Studien deuten auf einen Zusammen-
nation revealed crepitation of the left TMJ and a trigger point hang zwischen TMG- und ISG-Erkrankungen hin, dessen
in the masseter muscle. Range of motion of the spine and hip genaue Natur jedoch ungeklärt ist. Bei der Neuraltherapie
joints were normal, Patrick and Geanslen tests were positive (NT) werden zur Schmerzbehandlung Lokalanästhetika
on the left side. Spine and standing flexion tests were also injiziert, um ein dysfunktionales autonomes Nervensys-
positive. Magnetic resonance imaging of the lumbar spine tem zu normalisieren, das für die Initiierung oder Aus­
and sacroiliac joints were normal. A diagnosis of SJD was breitung chronischer Schmerzen verantwortlich gemacht
made, and the patient was treated using NT. Injections of li- wird. Eine 31-jährige Frau stellte sich mit einer einjährigen
docaine 0.5% to the left TMJ, the masseter muscle and intra- Vorgeschichte von mechanischen Kreuzschmerzen links
dermal segmental injections at the level of C4 were adminis- und nächtlichem Bruxismus vor. Die Untersuchung ergab
tered. The patient’s back pain and TMJ tenderness reduced eine Krepitation des linken TMG und einen Triggerpunkt
and continued so throughout the 3-month follow-up period. im Musculus masseter. Der Bewegungsumfang der Wir-
SJD may be related to TMJD, and NT may be used in its treat- belsäule und des Hüftgelenks war normal; der Patrick-
ment. © 2021 S. Karger AG, Basel und der Gaenslen-Test waren auf der linken Körperseite
positiv. Auch Wirbelsäulen- und Stehflexionstests waren
positiv. Magnetresonanztomographien der Lendenwir-
130.209.6.61 - 8/13/2021 4:30:22 PM

[email protected] © 2021 S. Karger AG, Basel Selin Ozen

www.karger.com/cmr Department of Physical Medicine and Rehabilitation
Başkent University Faculty of Medicine
Glasgow Univ.Lib.
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5. Sokak, No. 48, TR–06800 Çankaya, Ankara (Turkey)

selinhassan @ hotmail.com
 belsäule und des ISG waren ohne Befund. Eine ISG-Er- Case Presentation
krankung wurde diagnostiziert und die Patientin mit NT
A 31-year-old female patient presented to the outpatient clin-
behandelt. Dazu wurden Injektionen mit Lidocain 0,5% in
ic of the Physical and Rehabilitation Medicine Unit with a 1-year
das linke Temporomandibulargelenk, den M. masseter history of left-sided low back pain which was mechanical in char-
und intradermal-segmental auf Höhe von C4 verabreicht. acter with occasional morning stiffness lasting for 10 min. She
Rückenschmerzen und TMG-Druckschmerzempfindlich- gave her back pain a score of 7/10 on a visual analogue scale
keit nahmen ab; die Verbesserung hatte über den gesam- (VAS). The patient had no significant comorbidities. The system-
atic medical history revealed a history of sleep bruxism, but no
ten Nachbeobachtungszeitraum von 3 Monaten Bestand.
pain on mastication. On examination, palpation of the left TMJ
ISG- und TMG-Erkrankungen sind möglicherweise mitein- revealed crepitation with a trigger point in the masseter muscle.
ander verknüpft, und die NT stellt möglicherweise eine There was no jaw occlusion or pain on jaw movement. Examina-
Behandlungsoption dar. © 2021 S. Karger AG, Basel tion of the spine revealed a normal range of motion of the cervical
and lumbar spines and hip joints. Patrick and Geanslen tests were
positive on the left side. The spine and standing flexion tests were
positive on the affected side. The examination findings were con-
sistent with SJD and joint hypomobility [11, 12]. Routine blood
Introduction tests were normal, and no pathological findings were detected on
magnetic resonance imaging of the lumbar spine and SIJs. A deci-
Temporomandibular joint disorders (TMJD) includ- sion to treat the patient’s back pain using NT was made; an ultra-
sound-guided injection of 1 mL lidocaine solution 0.5% to the left
ing myofascial pain dysfunction, temporomandibular TMJ was performed. Trigger point injection of the masseter mus-
joint (TMJ) dysfunction, dislocation, osteoarthritis, disc cle, intradermal segmental injections at the level of the C4 seg-
disorders, chronic hypermobility, bruxism, ankylosis or ment and spinous process and 0.5–2 cm lateral to the process on
auto-immune conditions such as rheumatoid arthritis the left side (approx. 0.25–0.5 mL per injection) were adminis-
commonly occur in the general population with symp- tered.
A day later the patient’s low back pain had reduced to 1/10 ac-
toms reported to occur in up to 33% of the general popu- cording to the VAS. The tenderness at the TMJ was also relieved.
lation [1–4]. The most frequent complaint is of facial Painless well-being lasted throughout the 3-month follow-up pe-
pain, the onset of which can be both acute and chronic riod with no side effects of treatment.
[5].
Sacroiliac joint dysfunction (SJD) is one of the most
frequently seen causes of non-discogenic low back pain.
With a reported incidence of 10–27%, it is also held re- Discussion
sponsible for mechanical chronic hip or leg pain [6]. Pre-
vious studies have evaluated the relationship between the The relationship between the craniomandibular sys-
craniomandibular system, namely occlusal disturbances tem and the SIJ and the mechanism relating the two
of the TMJ, cervical spine and sacroiliac joint (SIJ) and remains unclear. This is the first reported case of a pa-
found coexisting dysfunction in all, suggestive of a func- tient with both SJD and TMJ complaints in which NT
tional coupling of these areas [7]. Cases of TMJD success- to the TMJ relieved the symptoms of pain in the lum-
fully treated using sacro-occipital manipulative treat- bosacral region as well as treating the tenderness at the
ment and cotreatment of lumbosacral pain and malocclu- TMJ.
sion by a chiropractor and dentist resulting in remittance The patient’s main complaint was chronic low back
of low back pain have been reported in the literature [8, pain, further questioning revealed a history of bruxism
9]. and tenderness of the TMJ with a local trigger point on
Neural therapy (NT) is a treatment system in which examination. Even though it is difficult to explain the re-
local anaesthetics (LAs) are used to relieve pain by nor- lationship between TMJD and SJD, in a previous study of
malising a dysfunctional autonomic nervous system dental students, Fink et al. [7] showed a correlation be-
which is held responsible for initiating or propagating tween functional abnormalities of the TMJ and SIJ which
chronic pain [10]. NT can be applied as a local therapy, was thought to occur due to ventrodorsal muscle imbal-
for example, infiltration of trigger points or intra-periar- ance. In the case described here, NT was used in the si-
ticular injections, and as a segmental therapy, for example multaneous treatment of the patient’s jaw and lumbosa-
infiltration of sympathetic ganglia, nerve roots and pe- cral pain with good effect.
ripheral nerves. In this case, the reduction in lumbosacral pain and
Here we present the case of a patient presenting with TMJ tenderness continued for the duration of the 3-month
low back pain and a long history of bruxism in which NT follow-up after injection. LAs have anti-inflammatory ef-
was applied to the TMJ resulting in a regression of the fects in addition to nerve-blocking and membrane-stabi-
patient’s back pain. To date, such a case of SJD and TMJD lizing effects. LAs can also restore decreased blood flow
treated using NT has not been described in the literature. to tissue by breaking the vicious circle of sympathetic sys-
130.209.6.61 - 8/13/2021 4:30:22 PM

380 Complement Med Res 2021;28:379–380 Boluk Senlikci/Ozen

DOI: 10.1159/000513131
Glasgow Univ.Lib.
Downloaded by:
tem activation – a system which has a pathological mem- Statement of Ethics
ory responsible for musculoskeletal pain [13]. Thus, LAs
The subject of this case report has given her written informed
used in NT are believed to reduce pathological nocicep- consent to publish her case.
tive activity and eliminate the pathological memory of the
sympathetic nervous system thereby providing long-term
pain relief [14]. Conflict of Interest Statement
In this case the response of the patient to treatment
suggests that craniomandibular disorders may have a The authors have no conflicts of interest to declare.
pathogenetic influence on the SIJ, and NT may be used
for pain relief in such cases. Therefore, when faced
with a patient with low back pain, it would be reason- Author Contributions
able to question craniomandibular complaints and in- Huma Boluk Senlikci: care and follow-up of the patient, draft-
clude an examination of the TMJ followed by investi- ing of the manuscript, critical appraisal of the final draft of the pa-
gations of these anatomical areas where it is deemed per.
appropriate. Selin Ozen: follow-up of the patient, drafting of the manuscript,
critical appraisal of the final draft of the paper.

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Sacroiliac Joint Dysfunction Treated Complement Med Res 2021;28:379–380 381

Using Neural Therapy DOI: 10.1159/000513131
Glasgow Univ.Lib.
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