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Chronic cough or hiccups – Irritation of the phrenic nerve – Strange Sensations Series

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In the first segment of our “Strange Sensations” series, we discuss chronic coughing, hiccups, GERD, inability to clear the throat, and other related symptoms that are associated with vagus and phrenic nerve irritation due to cervical instability.

Today i want to review with you an interesting case of a patient that had chronic coughs and nobody could figure out what was wrong and before we do that i wanted to ask you do have you ever known anybody that just continues to get hiccups you know every time they eat or drink a certain fluid and they’re constantly having the hiccups and you have to come up

With all sorts of ways to try to get them to go away like saying a special word or having them hold their breath well that is also something we’re going to be discussing today so just really tune in because this will be really interesting yeah dr hutchinson it’s actually a pretty common complaint you know the most common complaint we get of course is like people

Feel like their food’s caught you know their their food’s caught they got swallowing difficulties but close to that is people who get diagnosed with gastroesophageal reflux like they you know they cough they cough they cough they cough and most commonly you know they’ll go to a gi doctor or gastroenterologist and then they get the diagnosis of gastroesophageal

Reflux other folks of course they’ll go to an ent doctor then the ent doctor looks at their vocal cords and blah blah blah and then they say that no your vocal cords are fine so there’s nothing that we can find but what everybody’s forgetting is the neurology is the neurology and you know one of my most common things i say often i can’t say it enough whatever

A complaint you have whatever chronic symptom you have always follow the neurology you have to follow the neurology you have heart arrhythmias follow the neurology you have your stomach doesn’t work follow the neurology and you know often we talk about the neurology shows that the problem is a vagus nerve problem when we talk about chronic cough of course

Or chronic hiccups but chronic cough is a lot more common is that you first got to think about maybe the sensors right the sensors in the back of the throat the sensors in the esophagus sensors in the the pharynx might be off so what is the nerve that handles sensation in those areas it would be the vagus nerve yeah and then the vagus nerve of course supplies

The recurrent laryngeal nerve which is the vocal cords so vagus nerve problems can cause chronic cough by two mechanisms screwing up the vocal cords and of course screwing up sensation but another nerve that a lot of people don’t think about or you don’t hear a lot about maybe it’s not as sexy as the vagus nerve if i can say that still on youtube videos is uh

Is the phrenic nerve so why don’t we talk about that the phrenic nerve is formed from cervical nerve roots number three to number five which involves cervical vertebrae number two which is the axis and it goes all the way down to c6 so any type of instability on this side of course could lead to a phrenic nerve problem so this is just an illustration showing

The origins and if we could see the next one and then why don’t you just talk about it it’s a windy course right yeah so the phrenic nerve besides originating from the upper cervical spine it also passes usually between the anterior and middle scalene muscles which can get very tight and atrophied when you have any cervical instability forward neck carriage

Or a chronic problem with your neck so your musculature could pinch down and cause a problem with that phrenic nerve or you could have a male positioning in one of the bones in your neck which could cause it to be pinched down or irritated so you know it could be cervical instability it could be so many things it could irritate that phrenic nerve it’s actually

Really interesting doc because i’ll have patients that we have to do an anterior adjustment on about c3 or c4 so literally we have the adjusting instrument right about here it’s a very sensitive area so it’s a super low pressure and we do it the the best we can and when we click right about there on c3 c4 people will cough and so it’s so interesting yeah because

It’s irritating that phrenic nerve so it’s one of the side effects sometimes of an adjustment but it’s usually in people that either have instability in that area so they already have that nerve kind of a heightened sensitivity or they have had a chronic muscle spasm where those muscles of scalenes are really pinching down tight around that phrenic nerve yeah

And then we should of course say the phrenic nerve innervates the diaphragm so the diaphragm is the main breathing muscle so obviously if the diaphragm isn’t moving correctly you know up and down that of course can give you cough and then a common symptom also a shortness of breath i don’t know if you remember the last patient that we had like with chronic

Hiccups chronic cough it was probably about two or three weeks ago and then what that person had on both sides actually it was actually the c4 nerve root so when we did a digital motion actually which we’re not going to show and in this video but when they did it uh when they when they did extension there was a cut off of that c4 nerve root when they were in

Neutral and they were looking down the nerve root was fine so basically that would mean that every so often that the nerve flow through the phrenic nerve to the diaphragm of course was going to be decreased and of course that can cause malfunction of the diaphragm and then all kinds of symptoms yeah so this really illustrates it very good so we have c2 c4 then

We have uh basically all of this is going to it’s not labeled here but that’s going to be actually the phrenic nerve and obviously there’s other nerves that are associated with it again like this is clues that it’s a nerve root issue so for instance this goes the spinal accessory nerve goes to the trapezius and the sternocleidomastoid so if you had somebody

Who had chronic cough or chronic hiccups and they always had tension in their sternocleidomastoid muscle and their trapezius that would be a sign that at least on that side they probably are having cervical nerve root issues leading to the phrenic nerve issue chronic cough chronic hiccups so imagine like you have to struggle with every day that you’re gonna get

Hiccups like i’ve had i think the most i’ve ever seen is somebody who had it like 20 or 30 years it was like unbelievable wow you know unbelievable and then some people i mean they’ll they’ll use toxic medications i mean they’ll do anything to try to get rid of that hiccups and i should say it isn’t like they hiccup like continuously it might be just like you

Might just hiccup you know once every five minutes but it’s still like really really irritating and if you research hiccups you’ll see that it’s it’s it’s irritation of the diaphragm you know it’s the irritation of the diaphragm it’s it’s the diaphragm also that has you vomit so it’s you know irritation the diaphragm ultimately so it’s like that same sensation

Of like a hiccup is like a minor minor vomit because that’s basically what it is the diaphragm is irritated so the treatment should be again follow the neurology the neurology of the phrenic nerve the vagus nerve all these nerves lead you back to the neck and that means that you have to get the right scanning technique to show the problem which is digital motion

X-ray and then of course if cervical destructure is found then you do a dynamic ortho neurologic correction and if you find instability then you get prolotherapy which of course is very effective for cervical instability

Transcribed from video
Chronic cough or hiccups – Irritation of the phrenic nerve – Strange Sensations Series By Caring Medical