What is Chin on Chest Syndrome?
What is Chin on Chest Syndrome?
The cervical (or neck area) of the spine contains a natural inward curve. Neurological conditions, diseases, or trauma can alter this built-in curvature. In extreme cases, this can lead to a condition known as chin on chest syndrome. As the name suggests, this condition involves difficulty lifting the head upright into a normal position. In fact, resting the chin on the chest becomes the default position.
Sometimes known as dropped head syndrome (DHS), this neuromuscular disease affects a person’s quality of life and ability to function.
But, what causes chin on chest syndrome? And, more importantly, how can it be treated? Let’s start by taking a closer look at the cervical spine.
Understanding the Cervical Spine
As you probably know, the spinal column consists of a series of bones, known as vertebrae, that run from the base of the skull to the tailbone. The spinal column protects the spinal cord and supports the body, all while enabling movement.
Seven vertebrae—extending from the base of the skull to the upper back—make up the cervical spine. Intervertebral discs separate and absorb shock between each vertebra. In addition, a series of muscles and other soft tissues supports the spine. Furthermore, facet joints, at the back of the spine, allow us to complete bending and twisting motions. Nerve roots that connect to the spinal column exit from these joints and extend out to the rest of the body.
While some may think that the spinal column is straight, it actually has natural curves that support the body’s weight and movements. In reality, the cervical spine contains a slight inward curvature—known as lordosis. This curve relies on the discs, facet joints, muscles, and soft tissues to remain stable.
Chin on Chest Syndrome
In rare cases, the structures of the cervical spine lose the ability to keep the head upright. This reverses the normal curvature of the cervical spine. Cervical kyphosis, yet another name for chin on chest syndrome, describes an outward curve of the vertebrae in the neck. Moreover, progressive structural damage to the spine increases this abnormal curve. As the neck extensor muscles get weaker, it causes a flexion deformity (the inability to straighten the neck).
Symptoms of Chin on Chest Syndrome
A “syndrome” describes a condition involving related symptoms. For example, those with dropped head syndrome may experience:
- Visible changes to the shape of the spine
- The chin normally rests on the chest
- Difficulty holding the head upright or gazing upward
- Decreased range of motion in the neck
- Neck pain
- Extending the neck becomes easier while lying down
- Weakness or numbness in the extremities or entire body (i.e. global weakness)
- Difficulty controlling the bladder or bowels
- Trouble eating or swallowing
- Impaired horizontal gaze
Depending on the cause, these symptoms may develop suddenly or gradually. Mild cases may not exhibit many symptoms. However, more severe symptoms will occur when the curve of the spine is so severe that it applies pressure to the nerves or spinal cord.
Causes of Chin on Chest Syndrome
Several underlying conditions are associated with chin on chest syndrome. These include:
- Ankylosing Spondylitis (AS): A form of arthritis that causes inflammation of the spinal joints. As the disease progresses, new bone formations cause parts of the spine to fuse together, becoming immobile. AS can also affect other areas of the body including the hips, shoulders, ribs, hands, and feet. Specifically, genetics and environmental factors can trigger this disease.
- Parkinson’s Disease (PD): A progressive nervous system disorder that affects dopamine levels and nerve cells in the brain. PD leads to shaking, stiffness, and difficulties with balance and coordination. As the disease progresses, individuals develop a tendency to lean forward, contributing to structural changes in the cervical spine.
- Rheumatoid Arthritis (RA): An autoimmune disorder that causes chronic inflammation in the joints as well as other areas of the body. Autoimmune disorders cause the body to attack healthy tissues. As the disease progresses, it can affect the spine, leading to DHS.
- Amyotrophic Lateral Sclerosis (ALS): This motor neuron disease causes a disconnect in the communication between the nervous system and muscles. As a result, the muscles start to waste away—including those that support the cervical spine.
- Strokes: The neurological damage caused by a stroke can also affect the way in which the brain communicates with the muscles that control the neck.
- Cancer: Head or neck cancer—or the effects of treatment—can result in loss of function to the cervical muscles and/or nerves.
- Cervical Spondylotic Amyotrophy (CSA): A disease that causes a degenerative change in the cervical spine. CSA may lead to compression on the spinal cord and/or nerve roots, causing neuromuscular symptoms.
- Injuries or previous surgeries to the area: Cervical kyphosis may occur after surgeries such as a laminectomy. In addition, neck trauma can cause compression fractures that alter the cervical spine.
Diagnosis & Treatment of Chin on Chest Syndrome
As you can see, addressing chin on chest syndrome can be complicated. However, successful treatment starts with diagnosing the correct cause of the syndrome.
Diagnosing the Problem
Effectively treating chin on chest syndrome starts with accurately diagnosing the underlying causes. A doctor will initially review your complete medical history and conduct a thorough physical exam.
A general practitioner may refer you to a doctor who specializes in neuromuscular diseases. Depending on your current health and medical history, a wide array of tests may be ordered. Your doctor may also wish to obtain a closer look at the area using X-rays or MRIs. In particular, these tests can reveal the extent of damage to your neck.
Treating the Disorder
Both conservative and surgical options can be used to treat dropped head syndrome. However, the correct route for you often depends on the symptoms, causes, and damage to the cervical area. Treating the underlying causes with medications and a multidisciplinary approach may be sufficient to decrease deformity and improve quality of life.
Conservative treatments aim to reduce symptoms and strengthen the neck muscles. Physical therapy or physiotherapy can allow a person to correct postural imbalances and bodily movements. In addition, prescribed exercises and manual manipulation can increase range of motion and strength. Orthotic devices, like a neck brace, may also help to control pain and reverse deformity.
Surgery for cervical kyphosis may be necessary if your neck deformity is severe and causes chronic pain. Also, any pressure on the spinal cord or nerves may require surgery to prevent further damage and/or serious neuromuscular complications.
For example, a cervical deformity may require multilevel spinal fusion. This procedure can correct the abnormal spinal curve by permanently fusing together the affected vertebrae into a more ideal position. For some, a posterior spinal fusion (surgery initiated from the back of the neck) is recommended.
During fusion surgery, bone grafts and other surgical hardware are inserted into the spine to align and stabilize the area. In time, the affected vertebrae fuse together, preventing further deterioration of curvature.
Multilevel spinal fusion can be a complicated surgery with long recovery times. The results, however, can significantly improve a person’s deformity and quality of life.
Ready for Help?
Dr. Jason E. Lowenstein, an award-winning doctor who specializes in spinal deformities, can help diagnose and treat chin on chest syndrome. Using the latest technology and advancements, Dr. Lowenstein will empower you with both conservative and surgical options, so you can get back to the life that you want.
Successfully treating complex spinal conditions requires an experienced and patient doctor. Dr. Lowenstein has founded his career on helping those with major spinal deformities. As a repeat “Top Doctor” recipient, Dr. Lowenstein’s knowledge and compassion will change the course of your life. Schedule a consultation with Dr. Lowenstein today and achieve a better tomorrow!