Author: Aaron Suzuka, MD
Co Author #1: Celina Mercer, MD, MPH
Co Author #2: Christian Fulmer, DO
Editor: Drew Duerson, MD

Patient Presentation:
A 32 YO F fitness instructor with a history of eczema and seborrheic dermatitis presented to the clinic for ED follow-up on neck pain ongoing for 18 days.

History:
In the ED, she was diagnosed with torticollis and discharged with ibuprofen, baclofen, and capsaicin which did not improve pain. She had worsening pain with radiation down the right arm with paresthesias and weakness in her hand.
Because of her pain, she was unable to work as a HIIT fitness instructor and she had worsening sleep. Her only prior trauma was a car accident in 2014 where she suffered neck and back pain that improved with physical therapy. Her medical history included eczema controlled with triamcinolone and seborrheic dermatitis controlled with ketoconazole shampoo. She otherwise had no other medical conditions. She was prescribed prednisone for presumed cervical radiculopathy with improvement of pain at interval phone follow-up. MRI was ordered to re-evaluate diagnosis as patient continued to have pain .

Physical Exam:
General: Used pillow to prop up right arm and head was tilted slightly to the right. Vitals: 98.3F, HR 78, RR 18, 145/89. Neck: decreased ROM with flexion, extension, lateral bending and rotation with pain on right side of the neck. Tenderness over the right paraspinal muscles and trapezius. Spurling's was positive on the right. Right Arm: decreased sensation down the arm and decreased strength, but exam was limited due to patient's pain. Left arm: Normal ROM and sensation. Lower Extremities: Normal sensation and strength. Skin: no rash, erythema, or warmth noted over neck or arm.

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