Bilateral hand dystonia following high-velocity thrust manipulation: a case report

Area of Science:

• Musculoskeletal Medicine
• Neurology
• Clinical Case Reports

Background:

• Thrust manipulation is a widely used clinical technique for musculoskeletal pain management.
• It involves applying high-velocity, low-amplitude forces to joints, aiming for cavitation.
• Adverse events, though rare, warrant investigation.

Purpose of the Study:

• To report a rare case of dystonia following bilateral thrust manipulation.
• To describe the clinical presentation, diagnosis, and management of this complication.
• To raise awareness among clinicians regarding potential adverse effects of thrust manipulation.

Main Methods:

• Case report of a female patient in her mid-20s presenting with involuntary hand muscle contractions.
• Clinical assessment, diagnosis of complex regional pain syndrome (CRPS) type I with dystonia.
• Evaluation of treatment responses to prednisolone, botulinum toxin, and a combination of trihexyphenidyl, diazepam, and baclofen.

Main Results:

• The patient developed bilateral, involuntary hand muscle contractions (dystonia) post-thrust manipulation.
• Prednisolone improved CRPS symptoms; botulinum toxin was ineffective for dystonia.
• A combination of oral medications (trihexyphenidyl, diazepam, baclofen) significantly reduced dystonia, but did not achieve complete resolution.

Conclusions:

• Dystonia is a rare but potential complication of thrust manipulation.
• Early recognition and appropriate management are crucial for patients experiencing such adverse events.
• Clinicians should maintain awareness of this rare sequela to ensure patient safety.