Orthopedic Physical Therapy Treatment for Chronic Nontraumatic Atlantoaxial Rotation Subluxation (Grisel Syndrome): A 6-Year-Old Female Case Report

Abstract

BACKGROUND: Grisel syndrome (GS) is a rare kind of atlantoaxial joint subluxation (AAJS) in children due to infectious or inflammatory processes of the head and neck region. This case report aims to present the orthopedic physical therapy treatment and outcomes of a case with GS. CASE PRESENTATION: A 6-year-old girl with AAJS, diagnosed 3 months after a severe bout of tonsillitis, was studied. Her physical examination revealed that cervical spine active range of motions was limited. Computerized tomography showed fixation of the atlantoaxial joint consistent with type II AAJS. The patient was treated with orthopedic physical therapy (ie, a combination of myofascial release, manual traction, a home exercise program, and a cephalo-cervicothoracic splint) for 4 weeks. OUTCOME AND FOLLOW-UP: After the treatment, the AAJS decreased, pain and cervical range of motions improved, and a normal posture of the head was regained. At the follow-up periods (in the third and twelfth months), the patient reported no pain during active cervical movements, and the active range of motions was optimal. DISCUSSION: The significance of this case report lies in the successful management of a conservative treatment approach for GS. The findings obtained in this case study suggest that physical therapy could be a successful option for the treatment of chronic GS. JOSPT Cases 2022;2(4):196–203. Epub: 12 October 2022. doi:10.2519/josptcases.2022.10883