All three of these symptoms can be rated separately under hearing loss, tinnitus, and peripheral vestibular disorders, or shared under Menieres disease as follows: In September 2010, VA published The Duty MOSNoise Exposure Listing. If two exams record the diagnosis differently, the exam featuring the most comprehensive data and is performed by the most qualified specialist in that sector will be the exam the rating is based on. doi: 10.1111/ene.13512. Next steps I should take?You obviously are very knowledgeable, and thoughtful. Designed as an at-home exercise tool, our kits provide an easy and affordable option for home training in visual and vestibular therapy. When applying for VA benefits for vertigo and hearing conditions, certain principles apply. In addition to vertigo and dizziness, trigeminal nerve compression may cause tinnitus, tremendous temple headaches, eye pain, palatine pain, tooth aches, cheek sensitivity, ear pain, etc. Costen attributed the symptoms to temporomandibular joint dysfunction consequent upon mandibular overclosure with distal condylar displacement. foggy brain, like a flu, but only in the head. Thoracic outlet syndrome may be ameliorated by strengthening the scalenus anticus and medius carefully, along with postural changes. However, a common tendency of people who are very stressed, scared, anxious etc., is that they hold their breaths and brace their bodies. A third patient, aged 32, had marked unilateral, high-frequency, central heari ng loss with normal vestib I had an MRI with contrast at the beginning of the year which showed slight scoliolis in my neck and arteries being slightly pressed on. Other illnesses, as well as genetic and environmental factors, may also cause or contribute to vestibular disorders. When filing a service connection claim for vertigo, veterans should also submit any evidence that is relevant to the claim. In the week before this happened I started running for an hour at night for the first time in years. Uemura et al., 1972, MANDIBULAR joint neuralgia (Costens syndrome), first reported by Costen in 1934,1is accepted by otorhinolaryngologists and members of the dental profession as a definite clinical entity. Paparo et al., 2008, Normal spacing between the roof of the glenoid fossa of the temporal bone and the condyle of the mandible should be approximately three mm to support the disk between them. Dadsetan & Skerhut, 1989, Rotational positioning of the head showed vertebral obstruction in one direction, and unobstructed filling of the vessel when the head was turned to the opposite side. Longstanding ICH may lead to dural perforation (especially in susceptible patients, such as those with Ehler-danlos syndrome (EDS)) with concomitant CSF leakage and sudden intracranial hypotension (Higgins 2015). Poor posture for 16 hours and then 2 minutes of corrective exercise is a futile strategy and needs not be attempted. Gene association studies Unfortunately, theres no cure for Menieres disease. It can also be recorded in some healthy subjects and can be induced in normal patients by caloric or optokinetic testing. Neurology. They are always eager to help and answer questions. Some of the more known types of vestibular impairment, are BPPV (benign positional paroxysmal vertigo), Menieres disease, vestibular migraines, idiopathic dizziness, cervicogenic dizziness, vestibular neuritis, car sickness, boat sickness, etc. Saxton EH, Miller TQ, Collins JD. It should be considered in every differential diagnosis of recurring facial pain. Ciuman RR. It has been well documented that patients with TMD may struggle with symptoms of trigeminal neuralgia as well as vestibular impairment (Levandowski 2008). The glossopharyngeal nerve may become entrapped between the styloglossus and stylohyoid muscles. The patient must stop hinging at the neck and tucking their chin and follow the guidelines which I outlined above as well as. 2003. Ferrary & Sterkers, 1998, It has also been shown that, the distal portion of the endolymphatic sac, although it may be large in size may not have any discernable confluent area within it and that it may also overlap the sigmoid sinus (Friberg et al, 1988). Thus they both have a common ground in coronal movements, but are unique in perceiving longitudinal and sagittal movements. It takes time to get to the point of chronic vestibular dysfunction. If a veteran fails to attend a C&P exam, without informing VA ahead of time, their claim could be denied. Kjetil Larsen is a Researcher and a injury rehabilitation specialist, and is the owner of MSK Neurology. Do you really have atlantoaxial and craniocervical instability? Treatment for vertigo typically depends on what is causing the condition, and in many cases, it may go away on its own. I think I might be a clencher.. 8:Sagittal MRI: Conspicuous forward subluxation. My posture is also very bad. Once a claim has been filed for vertigo, VA may request a Compensation and Pension (C&P) exam to examine the veteran. ever since i have been stuck with this 24/7 constant dizziness. Hi, this is too much for a blog comment. Diagnosis and management of benign intracranial hypertension. The main scope of this article is to show WHY the neck and TMJ may greatly affect the vestibular system. Vestibular dysfunction is a disturbance of the body's balance system. If it is vagus nerve entrapment between the SCM and scalenus anticus, strengthening of these muscles will be appropriate intervention. Clinicians are encouraged to look for this valuable central vestibular system sign with eyes open in darkness for vertical nystagmus, which is more easily differentiated from eye blinks. As we know, when the vestibular system is damaged by injury or disease, the affected individual can experience effects including faintness, fatigue, nausea, anxiety, and difficulty with balance, and moving around (disequilibrium). DRAMMEN, NORWAY, Home From there it progressed to nausea, photophobia, loud sound sensitivity, pressure in head, pain behind eyes, eyes catching up to head movement An individual with vertigo will experience a sense of spinning dizziness. Vestibular disordersare quite common, and largely considered idiopathic. Both of these problems are known etiologies of chronic vestibular dysfunction. But I had no virus. In addition to providing a permanent, quantifiable record of eye movements, another important aspect of the ENG is that it permits eye movement recordings with loss of visual fixation, an important diagnostic test that helps localize a lesion. Vertigo can occur when theres a problem with the inner ear, brain, or sensory nerve pathway. The most traditional purpose of vestibular function studies is site-of-lesion localization addressing the sensory inputs, motor output elements, and neural pathways that may be involved in producing the reported symptoms. Balance disorders can strike at any age, but are most common as you get older. When the nerves which contribute to the tympanic plexus are compromised, e.g. The weird thing is that the features of the oscillopsia have changed a bit in that time, sometimes better and worse. High levels of anxiety, depression and somatization were recorded and considered psychogenic precursors of BPPV, thus emphasizing the role of psychological distress in precipitating peripheral vestibular disorders. i used to workout in the gym and lift weights. Vertigo is a sensation of feeling dizzy and off balance. Volume 2014 |Article ID 792635 | https://doi.org/10.1155/2014/792635. This resolves when the entrapment has been dealt with. 5 ml. It happens when a fragile structure deep inside your ear known as a labyrinth gets inflamed. Further, intermittent cerebral ischemia may also lead to vertigo on its own, as dizziness is a known pseudostroke symptom (Tehrani 2014). Fig. Fig. Vertigo can occur when someone looks down from a great height, but it often refers to any spells of dizziness that happens due to issues in the inner ear or brain. Selmonosky, C.A. Thank you so much for handling my appeals. JKSMRM 15:41-47(2011), Dashti SR, Nakaji P, Hu YC, Frei DF, Abla AA, Yao T, et al. Unfortunately, because these illnesses do not have an officially known etiology, proper testing may not exist. Migraine complicated by brachial plexopathy as displayed by MRI and MRA: aberrant subclavian artery and cervical ribs. Vestibular nerve neuritis is a common yet generic and often false diagnosis. Etiologies of this disorder are broadly categorized into peripheral and central causes based on the anatomy involved. We hope weve helped you understand the VA vertigo disability benefits you may be eligible for if you suffer from vertigo and any ear conditions. Only two patients showed unequivocal poststenotic dilatation as evidence of severe anterior scalene muscle compression. In condition 5, the platform sways and the eyes are covered, forcing the patient to rely on vestibular cues alonepatients with vestibular dysfunction tend to fall here. Surgery. Epub 2012 Feb 9. One of our VA disability lawyers talks about the importance of the Nexus Letter for service-connected disabilities. The distribution and arrangement of spindles within the muscle and their arrangement was studied. I had another similar episode mid Sept 2020, and that doesnt fit with labrynthitis. Loss of lumbar lordosis is causing patients to clench their abs in posture, inhibiting them from breathing properly. Selmonosky, C.A. Im still waiting to see a neurologist and Im starting to lose my mind thinking Im going to be like this forever. A vestibular migraine is a nervous system problem that causes repeated dizziness (or vertigo) in people who have a history of migraine symptoms. Thus, this article will expand upon these topics and explain the mechanism of dysfunction as well as how one may approach treatment. Either CNS disorder or peripheral vestibular abnormality 2015;35(13):5089-5096. doi:10.1523/JNEUROSCI.3922-14.2015. Silva & Selmonosky, 2011, Reports of transient blindness resulting from this condition are even more rare. Cervical spondylotic spurs and anterior scalene muscle or deep cervical fascia are among the factors which can compress the vertebral artery. A perforated eardrum can lead to hearing loss and can make your middle ear susceptible to infections. Intracranial pressures are intrinsically related to vestibular function. Other symptoms include burning tongue syndrome, throat pain, lumpy throat, chronic or periodic idiopathic dry cough, excess hiccups (phrenic nerve), tinnitus, dysphagia (swallowing difficulty), itchy throat, ear pain, etc. But not downwards. A service member who worked in a MOS that placed them near loud engines or machinery on duty, in combat experiences, or firing weapons can relate ear issues and vertigo to military service as a veteran. Similarly, there are few practitioners measuring the vertebral arteries with rotation of the neck. Selmonosky, 2007, The cases of 17 patients with vertigo, tinnitus, deafness, supraclavicular bruit, and a diminished radial pulse are reported. Contacting us does not create an attorney-client relationship. This book provides a framework for understanding the pathophysiology of diseases involving the vestibular system and outlines the important features in the patient's history, examination, and laboratory evaluation that determine the probable site of lesion. Eur J Neurol. 29: Very slight perfusion in the left IJV with good posture, Fig. A hyperactive nystagmic response following routine vestibular stimulation after lesions in the cerebellum were created is confirmed and criteria for this phenomenon is established. 24: Indicator of ICH (Osborns brain, 2017), Fig. That said, once the malady has progressed and matured, both posture and proper corrective rehabilitation is required to reverse the problem. I have suffered from barotrauma. For example, you may have sporadically worked near loud engines or something similar. 1) with nonlocalizing vestibular dysfunction, while a second had sudden, unilateral hearing loss of uncertain localiza tion, with bilaterally diminished vestibular function. All had subclavian-vertebral arteriograms preoperatively. Caloric tests have been carried out both in the presence of optic fixation and in total darkness upon normal subjects, patients with peripheral vestibular . The clinical history and comprehensive neurotologic examination provide the diagnosis for a large number of patients who report dizziness or imbalance. Jayaraman MV, Boxerman JL, Davis LM, Haas RA, Rogg JM. Perforated eardrums can result from middle ear infections, loud noises or blasts, severe head trauma, and more. In such case, a significant decline in systolic speeds will be noted upon doppler ultrasound of the vertebral artery (V2) between one foramen to the next (if a lesion is present). Background Medications - Many medications can affect test results. Intracranial pressures: Lumbar puncture opening pressures are known to be unreliable. Ill have a look at the head CT also. Using the information weve given you, you should understand what needs to be measured and recorded. She also exhibited other less severe brainstem symptoms. It is very common that one of the arteries are underdeveloped (hypoplasia), where the right artery is usually smaller than the left one (left dominant VA) (Pellerito & Polak 2012). Endolymphatic fluid is drained out from the ear via the vein of the vestibular aqueduct, and into the sigmoid sinus. i saw a upper cervical chiropractor who made my symptoms worse. Locke RR. The Annals of otology, rhinology, and laryngology. Hinge-neck postures may block the internal jugular vein, thus potentially creating a huge imbalance between arterial inlet and venous outlet, resulting in craniovascular saturation and intracranial hypertension. It is also regulated by the endolymphatic sac, as well by the tympanic plexus. Experimental Biology 2014 Meeting Abstracts V28, issue S1. Pellerito J, Polak J. Rotational vertebrobasilar insufficiency secondary to vertebral artery occlusion from fibrous band of the longus coli muscle. Unilateral vestibular hypofunction is the disturbance in function of one side of the vestibular system in the inner ear. 1998 Apr;65:S98-103. Fig. Each patient showed an anomaly of the vertebral artery system which allowed intermittent compression of either the origin or cervical course of the artery. Mokri B, Piepgras DG, Miller GM: Syndrome of orthostatic headaches and diffuse pachymeningeal gadolinium enhancement. These are called semicircular canals. PMID: 18379740. Your email address will not be published. Arch Intern Med. Clearly, with a blocked vein, one would expect higher levels than 11,5, unless there is indeed a leak. To be eligible for VA disability benefits for vertigo and ear conditions, you must first prove that your issues are the result of your time in military service. Hi, I have suffered with various symptoms for nearly a year including constant dizziness/feeling as though everything is slightly moving, headaches and eye pain, anxiety, jaw pain and dislocating. I will not elaborate upon this topic here, but rather you can read about it in my GICS article. The vagus nerve transmits between the scalenus anticus and clavicular head of the sternocleidomastoid muscles, and may become entrapped here. Hi. 153 0 obj <>stream All of the vestibular chambers are filled with endolymphatic fluids, just like in the cochlea, however the semicircular canals register movement of this fluid. Should I see a chiropractor? Woods and Woods, LLC, Veterans Disability Lawyer, Veterans Disability Benefits Attorneys Helping Veterans Nationwide, Published on May 11, 2020 by Mike Woods Last Updated on November 8, 2021. Clarke, 1962, Sectioning of the tensor tympani and stapedius muscle tendons significantly reduced the frequency and intensity of vertigo and improved both the functional profile and tinnitus. These organs sense movement in all directions and relay this information to the brain. (A) It suggests a right peripheral vestibular disorder of the labyrinth. (D) It suggests a central vestibular disorder KL TRENING & REHAB In order to do so, veterans should submit an initial claim usingVA Form 21-526. Anaesth Pain & Intensive Care 2018;22(2), Flanagan MF. It may also promote thoracic outlet syndrome, which as been implicated in intermittent vertebrobasilar insufficiency. 6: Compression of the internal jugular vein between the SP and C1 TP. Some patients require more time to recover than others, so the health professional or rating authorities can lengthen this period if necessary. This is harmless, but unnecessary. Dizziness is a common patient complaint that may indicate vestibular dysfunction is present. J Laryngol Otol. Then you may be experiencing vertigo, which is often a symptom of an ear condition. Surgical exploration revealed entrapment of the left vertebral artery by a tight anterior scalene muscle, release of which resulted in complete resolution of her symptoms. Do You Need Help Claiming Vertigo Disability Benefits? Fig. Vestibular crisis: sudden onset vertigo slowly improving from continuous to head movement provoked symptoms in days More likely to have auditory involvement Central vestibular or nonvestibular symptoms Sudden onset of vertigo, lightheadedness/imbalance with one of the Ds Slow-onset imbalance standing and walking Vague symptoms of any character 21: Relatively normal right IJV. Objectives To gain an understanding of: The role of the vestibular system in maintaining the stability of the visual world, the spatial orientation of the body, and its modulation of the. Vertigo is a sensation of feeling dizzy and off balance. %%EOF Ear conditions that can lead to vertigo include: Menieres disease is a disorder of the inner ear that can result in vertigo and hearing loss. 3. Incidence of extrinsic compression of the internal jugular vein in unselected patients undergoing CT angiography. That means that theVA disability ratingfor vertigo will usually offer a higher rating for more severe symptoms. The reason for this, is that the suboccipitals synchronize the head with the eyes movements. Booking 1999b;2:1732. 2: Saccular and utricular motion organs. This might happen when you tip your head up or down, when you lay down, or when you turn over or sit up in bed. But, if another condition exists thats in addition to vertigo or an ear condition (and isnt caused by it), then it can be rated too. Veterans can also submit lay statements explaining how this exposure to loud noises may have caused an innerear problemmarked by symptoms of vertigo. Around 2015 it was postulated that it may be related to venous congestion, so she underwent CT venography, however this exam was negative. The modest sensitivity and PPV helps with early detection of VBI, thus preventing risk of vertebrobasilar stroke in 84% to 64% of patients. (915.14). During the exam, the examiner may ask the veteran questions about their vertigo or their service. Knattlia 2, 3038 Here is a video explaining how VA math works to combine multiple disabilities to add up to a higher rating, but not always 100% disability. Subclavian steal syndrome. I am a 38 year old guy from Canada and since the morning of July 3rd, 2020 I have had a sort of 24/7 oscillopsia twinned with dizziness where when I move my head in certain movements, objects dont stay stable and blur, and brain fog, inability to think well. Barral & Croibier,Manual Therapy for the Cranial Nerves,2009. She was initially diagnosed with vestibular neuritis, but as time went by she started to develop other cognitive dysfunctions such as dysarthria (speech difficulty), confusion, disorientation, facial numbness and left-sided transient facial hemiparesis (facial paralysis, also known as Bells palsy or seventh nerve palsy). Received chiropractor assessment and discovered mechanical! For the horizontal semicircular canals, the movement toward the ampullated end (ampulopetal movement) causes greater stimulation than movement in the opposite direction (ampullofugal). The symptoms of peripheral and central vestibular dysfunction can overlap, and a comprehensive physical examination can often help differentiate the two. However, it also communicates with the trigeminal nerve via the otic and pterygopalatine ganglia as well as the vagus nerve via the glossophargyneal nerve. Vestibular dysfunction may be due to central causes (eg TIA / stroke / vertebro-basilar insufficiency, MS, tumours) or peripheral causes (eg BPPV, vestibular neuritis / labyrinthitis / meniere's). 2012 Aug;33(7):1247-50. doi: 10.3174/ajnr.A2953. However, I think it is counterintuitive to reject posture. One is especially predisposed to this problem with poor craniocervical postures and/or forward subluxation of the atlas (see my atlas article for more information). Cha YH. My gp has told me this would not be the cause of the constant dizziness I am getting but after reading your article I am not convinced. It may also become compressed between the scalenus anticus and the longus colli, at the scalenovertebral angle (Kojima 1985). Instead, there must be firm medical evidence confirming such symptomatology. Up until February working full time since 1978, and had planned togobacktowork but developed covid 19 symptoms March 8th no test done as none available until much later eventually tested in august and it was negative. Semin Neurol. Neurol Res Int. Prior the exam, the examiner will review the veterans c-file, which contains the veterans medical and service records. When they are adequately dysfunctional, meaning extremely weak, the patient may first experience dizziness during motion such as in the car or boat sickness. The vertebral arteries arise from the subclavian artery, runs through the transverse foramen between C6-C1, then enters the cranium to form the basilar artery. Dizziness and vertigo are symptoms of a vestibular balance disorder. have been excluded, i.e. Both of these patients were in their 50s. 2012;53(5):985-991. doi:10.3349/ymj.2012.53.5.985, Franz B, Anderson C. The Potential Role of Joint Injury and Eustachian Tube Dysfunction in the Genesis of Secondary Mnires Disease. When this nerve becomes inflamed, it affects the way information would usually be understood by the brain. PMID: 20352586; PMCID: PMC5682200. The site of obstruction occurred at the origin of the vertebralartery or cephalad to the level of C5. It is commonly seen in patients with thoracic outlet syndrome, as the scalenus anticus may compress the VA if it branches off the posterior side of the subclavian artery (Powers 1961). The guidelines were published in the Journal of Neurologic Physical Therapy in April 2016. 11,5 cm H2O (ref: > 10). However, studies show that also unilateral obstruction may still be clearly symptomatic (Cumurciuc 2005; Hyun-Ah Kim 2008; Thandra 2015; Zhou 2017). Many thanks, I look forward to hearing from you. Do you have any idea what this could be from? Bilateral vestibular hypofunction (BVH) is a heterogeneous condition that results from defects in either the vestibular organs, eighth cranial nerves, or a combination of the two. Motion sickness caused by moving your head. Generally, the problem may be ameliorated by improving cervical and scapular postures, as to decompress the IJV and SA. As most patients with a history of whiplash and associated disorders (WAD), this patient also had TOS (thoracic outlet syndrome). In severe cases, vertigo may also result in nausea, vomiting, and nystagmus (i.e., abnormal or jerking eye movements). Soler D, Cox T, Bullock P, et al. First and foremost he or she must resolve their poor posture. Vertigo and tinnitus are commonly linked through Menieres Disease. Either way, drainage will be impaired, and the pressure will build up. But to me my jaw was never corrected. This is why patients with neck and jaw disorders have a high prevalence of vestibular co-dysfunction, in my experience. Several factors, in addition to the obviously noted vestibulocochlear nerves (CN 8), may affect the vestibular system. Unlike traditional migraines, you may not always have a headache. 0 A shunt to drain out the excess CSF was installed, normalizing the ICP to around 15cm H2O. As vertigo is usually the symptom of other conditions and is commonly caused by ear conditions, the examiner may examine the veterans ears. Can you let me know the best treatment for somatic tinnitus?My posture has not been good since March 8 possible hyaloid muscles diagram 3 resembles my neck? It has been shown many times that biomechanical obstruction of the vertebral arteries may occur. Sometimes a low rating can also earn SMC to help beyond the monthly check that rating would bring in. Gweon HM, Chung TS, Suh SH. my life is hell and i know you guys are in norway but i was wondering if you had any recommendations for me? Testimonials However, it is important that the physician scans the V3 segment (the supraatlantal segment) and not the V2, in case of Bow hunters syndrome. The medical aspects of vertigo have nothing to do with heights, though. Heart races, palms sweat, and very nauseous like Im just getting off of a roller coaster. Start easy, and gradually build the muscles up. Franz B, Collis-Brown G, Altidis P, et al. Peripheral vestibular dysfunction in general is anything that affects the structures of the inner ear. Its important to note that this list was created as a guide for rating officials to follow when making decisions and its now no longer officially published by the VA. We'll also send alerts when VA law changes. Ocular blood flow is controlled both via direct autonomic influences on the vasculature of the optic nerve, choroid, ciliary body, and iris, as well as via indirect influences on retinal blood flow. Veterans who receive a rating for a balance disorder may be eligible to receive TDIU benefits. Left scalenectomy and rib resection confirmed the MRI and MRA findings; the scalene triangle contents were decompressed, and migraine symptoms subsequently resolved. In this report, we describe a patient with debilitating migraines, which were consistently preceded by unilateral arm swelling. This sensation can start and stop suddenly without warning. Additionally, abnormalities are often nonspecific and nonlocalizing, and do not provide . Hard to know as test done five months after symptoms . Im going to get another MRI soon. She suffered whiplash in the early 2000. If the MOS has a moderate probability, additional evidence of noise exposure may be required. BPPV can occur secondary to various other conditions including viral neurolabyrinthitis, Menieres disease, and vertebrobasilar ischemia [137]. Vestibular implant: Diagnostic testing. 2015;2015:794829. doi:10.1155/2015/794829. The vestibular organs are located in the inner ears, next to the hearing organs. Nonlocalizing finding, suggesting either a peripheral or central vestibular abnormality During the bithermal caloric tests, you find the following abnormality: "Bilateral weakness (BW) - Slow phase velocity on each side is less than 12 degrees per second." How do you interpret this finding? Considering time efficiency, and to avoid the effects of an artifact on the single largest beat, the 3-beat average may be preferred for calculating the SPV. While volume disturbances originating from out-of-balance transport processes anywhere in the labyrinth may be corrected by the sac, dysfunction of the sac itself is likely to have a substantial effect on endolymph status Salt, 2001. nr. You may be owed compensation. The patient will be scanned in the DeKleyns provocative position. Vestibular dysfunction is a vestibular disorder (a disorder relating to the inner ear and balance) that causes loss of balance and dizziness. : Surgical treatment of spontaneous spinal cerebrospinal fluid leaks. %PDF-1.6 % If the rating is high, then the rating staff will grant a service connection with little or no other evidence required. There have been reports of migraine and transient blindness occurring with rotation, where a tight scalenus anticus have ben found as culprit with dynamic angiographic examinations (Sell 1994, Saxton 1998). Hello, yes, I can help you with this. I have had the satisfaction of abruptly terminating two cases of Menieres disease during acute severe attacks by means of a procaine block. The AT nerve provides the somatosensory fibers that supply the joint, the middle ear, and the temporal region. If you can help me, I would be truly thankful, Book a session and provide me with at least a head MRI. And, finally, the lateral canal registers yaw, which is a longitudinal axis rotational movement. In these cases, vertigo can be considered a disability, and such patients may qualify for benefits from the VA. If there are two exams that seem to be equally as strong as the other with conflicting information, or if the condition can be equally valued under two different codes, then the one that offers the highest rating will be used. PMID: 27928352; PMCID: PMC5123161. 22: High-pressure splash-flow in right IJV in attempt to compensate for left stenosis. If this space is insufficient or reduced or restricted and the condylar head grows posterosuperiorly or is iatrogenically repositioned posteriorly or posterosuperiorly, the condyle will pinch this tissue and usually the result will be pain. Typical symptoms of TOS are pain between the shoulderblades, arm pain, carpal tunnel syndrome, radial neuralgia, migraines, neck pain, chest pain, breathing pain, and more (Larsen 2018b; Selmonosky 1982, 2002, 2008). 2002;77:1241-1246, Higgins N, Trivedi R, Greenwood R, Pickard J.
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