Author: Baylee Birkmeyer, MD
Co Author #1: Baylee Birkmeyer, MD
Co Author #2: Justin Mark J. Young, MD
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Michael Moreland, DO
A 59 year old male hiker with no past medical history presented to clinic for neck pain.
The pain began a month ago in his left shoulder after hiking the Kuliouou Ridge Trail. He was normally an active swimmer, runner, and sailor. The patient had been seen in the ED, a walk-in clinic, and via tele-health all by different providers. Previous therapies included opiates, NSAIDS, methocarbamol, gabapentin, prednisone, and chiropractor manipulation. The patient declined physical therapy due to pain severity.
He now described severe, sharp, shooting posterior neck pain radiating to his bilateral elbows. He could not fully extend his neck and the pain woke him from sleep. He denied trauma, prior neck injury, or neck or back surgeries. Social history was negative for IV drug use. The patient denied urinary or fecal incontinence, fevers, extremity weakness, numbness, or unexpected weight loss.
General: Patient sitting with neck in flexion. Alert, no acute distress
Respiratory: Breathing non-labored, non-dyspneic
Skin: No rash. No edema
MSK: Kyphotic posturing. Unable to extend neck due to pain. Very limited active range of motion in neck flexion, extension, rotation and lateral flexion due to extreme pain. Tenderness to palpation at the midline of C5, C6, and to a lesser degree C7. Biceps, triceps, and brachioradialis reflexes 2+ bilaterally. Sensation diminished to light touch over the bilateral upper extremities, most notably in the elbows and hands. Spurling's was positive.
Neuro: PERRL. CN II-XII intact
Psych: Normal affect. Normal behavior
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