PMC8288512_01
Pre- and post-treatment.
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Physical examination found a dystonic movement with a backward extension of the head and a forward sagittal shift of the neck that caused the chin to be pushed forward (Fig. 1). On examination 2 weeks postinjection, the patient had improved significantly in both head extension and forward sagittal shift, with minor neck pain (Fig. 1).
Hypertrophic semispinalis capitis muscles.
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The semispinalis capitis muscles were hypertrophic and overactive bilaterally (Fig. 2) and the trapezius muscles also showed increased activity bilaterally.