Cases reported "Shoulder Pain"

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1/13. Schwannoma of the suprascapular nerve presenting with atypical neuralgia: case report and review of the literature.

    Compressive lesions of the suprascapular nerve produce weakness and atrophy of the supra- and infraspinatus muscles and a poorly defined aching pain along the posterior aspect of the shoulder joint and the adjacent scapula. Entrapment neuropathy of the suprascapular nerve is fairly common whereas tumorous lesions are rare; among the latter ganglion cysts are frequently seen. An isolated solitary schwannoma of the suprascapular nerve presenting with atypical neuralgic pain is exceptional. The location of a schwannoma under the firm deep cervical fascia in the posterior triangle of the neck is implicated in the genesis of neuralgic pains mimicking the suprascapular entrapment syndrome. One such case is reported with discussion of the relevant clinical features.
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keywords = neck
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2/13. Two cases of isolated first rib fracture.

    Isolated first rib fractures are uncommon. They are usually associated with severe blunt trauma, although other mechanisms have been suggested, these being (a) indirect trauma, (b) sudden contraction of the neck muscles, and (c) stress or fatigue fractures attributable to repeated pull of muscles. Two cases are reported of stress fracture of the first rib, who presented to the accident and emergency department.
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3/13. Atlanto-axial subluxation syndrome and management of intractable headache, neck pain and shoulder pain with auricular stimulation: a clinical case report.

    Atlanto-axial subluxation syndrome is a condition that is easily overlooked, misdiagnosed and mismanaged. anatomy, neurovascular involvement and description of clinical manifestations are reviewed. Bi-Digital O-Ring Test is employed to establish an accurate diagnosis and its value and accuracy described briefly. Bi-Digital O-Ring Test has been an important diagnosis confirmation method (reconfirmed by CT or MRI in over 95% of more than 850 clinical cases) in this author's practice of spinal disorder and intractable pain management. A newly described device, the KIM-STIM, offers auricular stimulation of multiple points, using electrical microcurrent. Each unit is individually custom-molded to the patient's ear, and fitted with multiple electrodes. It was found to be very effective in managing the majority of intractable pain, especially pain requiring multiple daily treatments in order for the patient to live and function normally. The KIM-STIM device allows the patient to self-manage the pain, by day or night, thus allowing for a reduction or elimination of medication intake and diminishing the necessity for frequent doctor visits.
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ranking = 4
keywords = neck
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4/13. Misinterpretation of regional sensory loss in an injured worker: a case report.

    Regional patterns of motor or sensory loss are considered indicators of a behavioral component to the complaints of an injured worker. This assumption may lead to a discounting of signs and symptoms with premature return to work and discharge from care. We present the case of a 25-year-old airline baggage handler with an 8-month history of unresolved neck and shoulder complaints who had been returned to work after a lack of objective findings on physical examination. On physiatric evaluation, his unusual pattern of insensitivity to pinprick led to prompt magnetic resonance imaging that revealed a focus of increased intramedullary signal at C6 consistent with a syrinx. This case report shows the importance of a detailed neuromuscular examination coupled with appropriate diagnostic imaging in the assessment of individuals with regional sensory or motor loss so as not to miss more serious spinal cord pathology.
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keywords = neck
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5/13. pain perception in the older patient. Using the pain hologram to understand neck and shoulder pain.

    Pain is a common complaint and its perception is a complex issue. The older person with neck and shoulder pain may have contributions to that pain from multiple and diverse sources. These can range from nociceptive stimulation, neurologic sensitization, emotional issues, socio-cultural biases, cognitive interpretation and meanings of the pain to that person, concurrent medical and psychiatric illnesses, and memory (both pain and non-pain related memories). The affective dimension of pain can be more influential on a person's ultimate pain experience than the sensory-discriminative component, and both must be understood for each patient, in terms of it's relative weight in each pain. Neck and shoulder pain can represent eudynia and maldynia, or concurrent existence of both. To properly treat patients with this complaint, physicians must understand what comprises each individual's pain hologram and direct treatment at as many component parts as possible.
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ranking = 5
keywords = neck
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6/13. Transforaminal cervical blood patch for the treatment of post-dural puncture headache.

    A 40-yr-old woman received a series of three interlaminar epidural steroid injections for the treatment of axial neck pain secondary to degenerative disc disease. Immediately after her third injection, she experienced symptoms of a dural puncture-induced headache. This headache persisted on a daily basis for 3 mos, despite two epidural blood patches using an interlaminar approach, which was finally completely abated with a transforaminal blood patch. The headache was immediately relieved and remained alleviated through the follow-up interval of 1 yr. In this patient, a fluoroscopically guided transforaminal epidural blood patch proved to be more effective than the classic blind interlaminar approach in the treatment of post-dural puncture headache.
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keywords = neck
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7/13. Enthesitis of biceps brachii short head and coracobrachialis at the coracoid process: a generator of shoulder and neck pain.

    This series describes the outcome of diagnostic block at the coracoid process's common origin of the biceps brachii short head and coracobrachialis for anterior shoulder pain and cervical myofascial pain syndrome in six patients. All showed significant tenderness over the tip of the coracoid process. All underwent diagnostic injection with Marcaine at the coracoid process, followed by therapeutic injection with Marcaine and DepoMedrol. All reported complete relief of pain after local injection. Enthesitis at the coracoid process needs to be considered as a causative or contributing factor in patients presenting with shoulder and neck symptoms. No study was found in the literature describing this association. Whether tendonitis of the common origin is a primary cause or result of chronic neck and shoulder dysfunction remains to be established.
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ranking = 6
keywords = neck
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8/13. Condylar resorption during active orthodontic treatment and subsequent therapy: report of a special case dealing with iatrogenic TMD possibly related to orthodontic treatment.

    A 28-year-old female underwent orthodontic treatment for approximately 22 months. During the later stages of this treatment, the patient reported right shoulder and neck-muscle pain. In addition, temporomandibular joint disorder (TMD) with a 'clicking' sound during mastication commenced 5 months prior to treatment completion. Specific medication to deal with these symptoms was suggested by medical specialists, as were some stress-relief methods, although the pain still progressed, and subsequent clinical and radiographical examinations were undertaken by another orthodontist. Right mandibular condylar resorption was observed from both the panorex and temporomandibular joint (TMJ) radiographs. No clinical signs of rheumatic disease were observed, although bruxism was noted. Following the termination of the orthodontic treatment by the second practitioner, the patient was treated with splint therapy 1 month subsequent to which, the previous symptoms of pain in the shoulder and neck, and the clicking sound during mastication had subsided. During the 14-month period of splint therapy and follow-up, new bone growth in the right condyle was observed from radiographs.
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ranking = 2
keywords = neck
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9/13. Conservative treatment of a patient with previously unresponsive whiplash-associated disorders using clinical biomechanics of posture rehabilitation methods.

    OBJECTIVE: To describe the treatment of a patient with chronic whiplash-associated disorders (WADs) previously unresponsive to multiple physical therapy and chiropractic treatments, which resolved following Clinical Biomechanics of posture (CBP) rehabilitation methods. CLINICAL FEATURES: A 40-year-old man involved in a high-speed rear-impact collision developed chronic WADs including cervicothoracic, shoulder, and arm pain and headache. The patient was diagnosed with a confirmed chip fracture of the C5 vertebra and cervical and thoracic disk herniations. He was treated with traditional chiropractic and physical therapy modalities but experienced only temporary symptomatic reduction and was later given a whole body permanent impairment rating of 33% by an orthopedic surgeon. INTERVENTION AND OUTCOME: The patient was treated with CBP mirror-image cervical spine adjustments, exercise, and traction to reduce forward head posture and cervical kyphosis. A presentation of abnormal head protrusion resolved and cervical kyphosis returned to lordosis posttreatment. His initial neck disability index was 46% and 0% at the end of care. Verbal pain rating scales also improved for neck pain (from 5/10 to 0/10). CONCLUSION: A patient with chronic WADs and abnormal head protrusion, cervical kyphosis, and disk herniation experienced an improvement in symptoms and function after the use of CBP rehabilitation protocols when other traditional chiropractic and physical therapy procedures showed little or no lasting improvement.
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keywords = neck
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10/13. Clinical diagnosis of vertebrobasilar insufficiency: resident's case problem.

    STUDY DESIGN: Resident's case problem. BACKGROUND: vertigo and visual disturbances are common symptoms associated with vertebrobasilar insufficiency (VBI), but the physical examination procedures to verify the existence of VBI have not been validated in the literature. The objective of this resident's case problem is to demonstrate how a patient's complaint of vertigo and visual disturbances, combined with positive clinical examination findings, can be a potential medical screening tool for VBI. diagnosis: The patient in this report was initially referred to physical therapy for neck pain. However, the patient's chief concerns identified during the history were (1) vertigo, (2) visual disturbances, (3) headache, and (4) right shoulder region pain. Clinical VBI tests were performed, whereby the patient's vertigo and visual disturbances were reproduced with cervical spine extension. The patient was sent back to the referring physician to be evaluated for possible VBI. diagnostic imaging tests were ordered. Carotid ultrasound revealed 80% to 90% stenosis in the proximal left internal carotid artery, and magnetic resonance angiography of the extracerebral vessels showed greater than 90% stenosis of the left internal carotid artery. DISCUSSION: VBI may be present in patients with subjective reports of vertigo and visual disturbances that are reproduced with VBI physical examination procedures.
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