Neck Pain in Recreational Bicyclist/Walker

Abstract

HISTORY: 54-year-old female athlete with congenital hip dysplasia status post bilateral hip replacement. During her rehab for recent hip surgery, she developed right shoulder tendonitis and neck pain. The pain is dull aching with numbness without radiation. She recalls that as a teenager she had difficulty turning her head due to “possible congenital neck disorder”. She denies any weakness, gait abnormalities, or cauda equina symptoms. Past Medical HISTORY: Menopausal, hypertensive cardiomyopathy, glaucoma, hearing loss. Meds: female hormones. PHYSICAL EXAMINATION: VS: normal. Bi-pedal, upright gait. Quad weakness noted in the right leg consistent with her postoperative status. Significant decrease neck ROM. ROM of shoulders is symmetric. Her strength is excellent except for mild weakness of external rotation. She has normal arm and leg reflexes, without clonus and with normal response to pin, light touch and vibration. A dextrolumbar levothoracic curvature and forward head posture is noted with level pelvis in standing posture. Her cervical and thoracic musculature is extremely tight. Her hairline is low. DIFFERENTIAL DIAGNOSIS: Myofascial pain DJD Facet Arthropathy Spondylolisthesis Spondylolysis Herniated disc Klippel-Feil deformity TEST AND RESULTS: Cervical spine: Fusion between C5 and T1 with a right hemivertebra at C2-C4. There is extensive facet disease with hypertrophic facet and uncovertebral arthropathy. CT without contrast: There are multiple congenital anomalies with fusion at the C2-3, C4-5, and C7-T1 levels, a butterfly shaped vertebral body at the C4 level and a hemivertebral body at C7. There is a defect in the left lamina at C2. There is fusion of bilateral C2-3 and C4-5 facet joints. There is approximately 4 mm anterolisthesis of C5 on C6 facet joint space. Uncovertebral spurring, right greater than left causing moderate right C6 neural foraminal narrowing. There is no focal disc her herniation at any level. FINAL WORKING DIAGNOSIS: Klippel-Feil Syndrome TREATMENT AND OUTCOMES: No spinal instability was present on flexion/ extension views of the cervical spine. The patient had marked reduction in cervical rotation upright that largely improved in the supine, relaxed position suggesting a significant myofascial component to her neck pain. She was treated with a combination of physical therapy directed at improving her forward head posture in conjunction with acupuncture directed at release of her trapezius, levator scapulae, splenii, and middle and posterior scalene musculature. After altering her physical therapy regimen in conjunction with 3 sessions of acupuncture, her neck and shoulder pain were quiescent.