Author: Will Paulson, MD
Co Author #1: Stephen Simons, MD, FACSM
Senior Editor: Michelle Szczepanik, MD
Editor: Mandeep Ghuman, MD, FAMSSM

Patient Presentation:
The patient is a 24-year-old female former division I collegiate swimmer with a history of scoliosis who presented with right neck pain.

History:
Five months ago she described a specific episode of sudden onset of pain in the right neck, shoulder, and back while stepping off of the subway carrying a backpack full of books. Around that time she also noticed shooting pins and needles down her arm into her right ring and pinky fingers. Following that she had associated weakness, stating she had a difficult time carrying her purse on her arm and it would quickly fatigue. Her pain gradually improved and a few weeks later had a reportedly normal neck MRI. One month ago she had a sudden return of these symptoms, right-sided neck pain shooting down into her shoulder, which she has intermittently had since the initial incident. Her pain is worse when sitting at a computer for prolonged periods of time. She also noticed prominent scapular winging about one month ago. She denied dizziness, rashes or skin changes, or vision changes. Since college she has continued to regularly swim and occasionally compete.

Physical Exam:
General: Vital signs within normal limits. Well appearing.
Neck: normal alignment. No tenderness to palpation. Full range of motion.
Back: mild lumbar levoscoliosis. mild thoracic dextroscoliosis. No tenderness to palpation. Full range of motion.
Right shoulder: scapular winging with wall push-up. Range of motion, full, including abduction without scapular winging. No tenderness to palpation. Neer's, Hawkin's, O'Brien's, and Speed's tests negative.
Neurologic: full strength and sensation throughout the upper extremities.

Case Photo #1

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