307 - Manipulating the Intractable: OMT for Hiccups in a Patient with Right Internal Capsule CVA and associated Left-sided Hemiparesis

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

LE

Lindsay M. Ellson, DO

Resident Physician
ECU
Greenville, North Carolina, United States

Co-Author(s)

HJ

Harrison Jordan, DO

Resident Physician
ECU
greenville, North Carolina, United States
RB

Ryan A. Brady, MD

Resident Physician
ECU Health Medicine Center - Dept. of Physical Medicine & Rehabilitation
Winterville, North Carolina, United States
PS

Paige Saito, DO

Resident
ECU Health
Greenville, North Carolina, United States

Submitter(s)

LE

Lindsay Ellson, DO

Ecu Health
Greenville, North Carolina, United States

Case Diagnosis: Sustained singultus in a patient with left sided weakness due to acute right internal capsule infarct

Case Description: 53 year old male patient with hypertension, current tobacco use, and multiple previous TIAs presented with left facial droop and left upper extremity hemiplegia after right internal capsule infarct. Patient received thrombolytics, progressed well through hospitalization and was subsequently admitted to in patient rehab (IPR). Singultus began approximately four days into IPR admission and was a notable barrier to therapeutic progress. To address, baclofen was initiated at 5 mg three times a day. However, this caused hypersomnolence and the patient was unable to participate meaningfully in therapies. Osteopathic Manipulative Medicine (OMM) was administered to address the musculoskeletal cause of hiccups via myofascial release (MFR) to hypertonic subocciptal muscles, facilitated positional release (FPR) to hypertonic left middle scalene, MFR for a diaphragmatic dysfunction, and muscle energy (ME) for a C2 rotated right and side bent right. Within hours of OMM administration, patient was hiccup free for twelve days.

Discussions: Cerebrovascular accidents within the internal capsule can lead to a wide range of deficits including upper extremity weakness and diaphragmatic dysfunction. A side effect of diaphragmatic dysfunction being singultus. Baclofen is indicated as a treatment for intractable hiccups but can also cause somnolence. At times, this side effect is severe enough to interfere with a patient’s ability to progress through therapeutic goals. Presented here is a case in which OMM was administered and alleviated hiccups, allowing a patient to complete their rehab stay less encumbered. Thus, OMM could be considered to address the musculoskeletal and myofascial causes of singultus without the same deleterious effects as oral medication.

Conclusions: OMM can be a useful tool to alleviate aggrevating hiccups in the setting of upper extermity hemiplegia after internal capsule ischemic stroke, especially in patients who cannot tolerate oral baclofen.