Neck Stiffness In A Collegiate Swimmer: Uncovering A Hidden Threat In The Training Room

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Neck Stiffness In A Collegiate Swimmer: Uncovering A Hidden Threat In The Training Room - Page #1

Author: Christian Kaschak, DO Senior Editor: Heather Rainey, MD Editor: Amy Valasek, MD, MS, FAMSSM Patient Presentation: An 18-year-old female division 1 collegiate swimmer presents to training room for mononucleosis follow-up complaining of neck pain and stiffness. History: An 18-year-old collegiate swimmer presents to the training room for mononucleosis follow-up after abstaining from sport for three weeks. She was incidentally diagnosed with acute mononucleosis during routine new athlete lab workup three weeks ago and developed sore throat and fatigue two days later. Two weeks ago, she noted worsening fatigue and developed poor appetite, alternating fever and chills, and a sore throat. The sore throat has mostly subsided, but her other symptoms have persisted. New symptoms include neck pain and stiffness that started over the last two days when she "slept on it (neck) wrong." She has been taking acetaminophen and ibuprofen for pain and fever with temporary improvement. Physical Exam: The patient is an alert, nontoxic, but uncomfortable-appearing female. The oropharynx is without tonsillar swelling or exudates. The neck has moderately tender and significantly enlarged anterior cervical lymphadenopathy bilaterally. Active range of motion of the neck is limited in rotation (45 degrees), flexion (40 degrees), extension (30 degrees), and sidebending (20 degrees). Muscle strength and sensation are grossly full and intact in bilateral upper and lower extremities. No midline cervical spinal tenderness to palpation. Negative Spurling's. Negative Brudzinski's and negative Lhermitte's. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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