23 y/o female presented with acute idiopathic neck pain. She explains she simply woke up with her neck stuck and spasmed. She was unable to drive herself and needed assistance walking from the car to the clinic.
She mentions she has never had this neck pain in the past. She describes the pain as a severe stabbing pain with associated deep shooting pain into the left upper trapezius. There is no referral pain distal to the left shoulder or inferior scapular angle.
She denied having any headache symptoms nor does she suffer from regular headaches.
She denied any history of recent trauma to the head or neck.
She denied any motor vehicle accidents within the last 18 months.
She had Difficulty with getting out of bed and difficulty with rolling over in bed. She also had difficulty with dressing oneself and shooting pain while sitting in a vehicle.
She explains her symptoms subside when she is very still and she has her head slightly turned to the right.
She recently started using two pillows while sleeping on her side/stomach.
VAS of pain = 8-9/10.
Observation; patient was visibly distressed and crying. Head was held in right rotation and slight flexion.
Cervical range of motion; Flexion = 11 – 15 deg. Extension = 15 deg. Right rotation = 45 deg. Left rotation = 5 deg. Right lateral flexion = 15 deg. Left lateral flexion = 5 deg.
Cervical facet compression (Kemps); Right positive for left sided neck pain. Left unable to test due to severity of pain.
Cough/Valsalva; mild positive for neck pain only.
Neurological examination; unremarkable.Reflexes intact bilaterally. Muscle strength good bilaterally.
Palpation; sensitivity and restriction at T2/3/4, C5/6/7 left sided.
Vascular Testing; Hautant’s/Maigne’s (Seated) & VBI (Supine); No abnormalities detected.
Education & Advice.
Cervico-Thoracic Mobilisations. (seated)
Cervical SNAGS (A seated facet joint mobilisation technique),
T2/3/4 seated tractional adjustments
C5/6/7 supine rotational adjustments (occured at the 3rd consult)
Gentle neck movements into pain free ranges.
After 2 consultations in the first week, the patients range of motion had improved by 50% in all movements. The neck pain was VAS 3/10.
After 4 consultation by the end of week 2, she reported full neck range of motion and VAS = 1/10
After 5 consultations by the end of week 4, she reported no neck pain and no shoulder pain. She had resumed all pre-injury activities.