Neck Range Of Motion Research Articles

Aesthetic Correction of Adult Unoperated Torticollis

A 24-year-old man presented to the plastic surgery clinic complaining of left-side neck persistent tightness sensation for years. He had a palpable broad fibrotic band over his left sternocleidomastoid muscle. In addition, it revealed mild but definite weakness by manual muscle test. Congenital muscular torticollis in adult is a treatable disease and usually mimics neurogenic cervical torsion dystonia. After the diagnosis was confirmed, he underwent resection of the left sternocleidomastoid muscle and underlying deep cervical fascia and relieving of extensive fibrosis. Postoperatively, his uncomfortable sensation improved, and there was no limitation of neck range of motion. After an autologous fat graft implantation to his left-side neck, there was a satisfied left-side-neck condition and aesthetic outcome.

The Therapeutic Effects of Acupuncture on Patients with Chronic Neck Myofascial Pain Syndrome: A Single-Blind Randomized Controlled Trial

Chronic neck myofascial pain syndrome (MPS) is a common disorder seen in clinics. There is no gold standard method to treat myofascial pain. We investigated the effects of acupuncture on patients with chronic neck MPS by a single-blind randomized controlled trial. A total of 35 patients were randomly allocated to an acupuncture group (AG) or a sham acupuncture group (SG). Each subject received acupuncture treatment twice per week for three consecutive weeks. The primary outcome measure was quality of life as assessed with Short Form-36, and secondary outcome measures were neck range of motion (ROM), motion-related pain, and Short-Form McGill Pain Questionnaire (SF-MPQ), as determined by a blinded investigator. The clinical assessments were made before treatment (BT) and after six acupuncture treatments (AT), as well as four weeks (F1) and 12 weeks (F2) after the end of the treatment. A total of 34 patients completed the trial. The results indicated that there is no significant difference in the ROM, motion-related pain, and SF-MPQ scores between AG and SG at AT, F1 and F2 (all p > 0.05). However, AG has greater improvement in physical functioning and role emotional of Short Form-36 quality of life at F2. The results indicate that acupuncture may be used to improve the quality of life in patients with chronic neck MPS.

Changes in cervical range of motion and sagittal alignment in early and late phases after total disc replacement: radiographic follow-up exceeding 2 years

This was a retrospective clinical study in which the follow-up period exceeded 2 years. The authors investigated the time course of radiographic changes in the cervical range of motion (ROM) and sagittal alignment after cervical total disc replacement involving the ProDisc-C artificial disc. Eighteen patients who underwent C5-6 total disc replacement were followed for an average of 27 months. Cervical neutral and flexion-extension lateral radiographs were obtained before and at 1 and 3 months after surgery for early-phase observations and at the last follow-up for late-phase observation. Segmental ROM values in the treated, superior, and inferior adjacent segments were measured. For whole-neck motion, C2-7 ROM was also measured. The percentage contributions of ROM at functional and adjacent segments to whole-neck motion were calculated. For evaluating sagittal alignment, C2-7 and C5-6 Cobb angles were measured. All data from ProDisc-C arthroplasty were compared with the results obtained in 22 patients who underwent C5-6 interbody fusion in which a Solis cage was used and who were followed for an average of 25 months. In the ProDisc-C group, C2-7 and C5-6 ROM significantly decreased in the early phase after surgery and returned to preoperative levels in the late phase. Both superior and inferior adjacent segments showed significantly decreased ROM in the acute phase after surgery and returned to the preoperative values in the late phase. In terms of contributions to whole-neck motion, the ROM of the functional and adjacent segments did not change significantly compared with the preoperative ROM. In the cage group, C2-7 ROM was also significantly decreased in the early phase after surgery and returned to preoperative levels at the late phase. Both superior and inferior adjacent segments exhibited significantly increased ROM and percentage contributions to whole-neck motion in the early and late phases. Sagittal alignment of the whole cervical spine became significantly more lordotic in the late phase in the ProDisc-C group. The C5-6 Cobb angle became significantly lordotic in the ProDisc-C group, whereas there was no significant change in C5-6 Cobb angle in the cage group. In the early phase after ProDisc-C replacement, the ROM of the entire neck as well as functional and adjacent segments decreased but, at the late phase, they returned to the preoperative state. Contributions of functional and adjacent segments to whole-neck motion were not changed after ProDisc-C replacement. Adjacent-segmental motion could be saved by ProDisc-C replacement instead of interbody cage fusion. Segmental degenerative kyphosis was significantly corrected in patients who underwent ProDisc-C replacement.

Balance Performance In Middle-aged Subjects With Cervical Spondylosis

Cervical spondylosis is a common progressive disorder in aging cervical spine. Sensory systems are important for balance maintenance. Poor postural control in older people is associated with increased risk of falling. PURPOSE: This study was to evaluate the impact of cervical spondylosis in the middle-aged group, compared with the young control group, on balance performance, neck range of motion (ROM) and isometric muscle strength. METHODS: Fifteen middle-aged subjects (age: 52±7years) with cervical spondylosis, diagnosed by cervical spine radiographs, and fifteen young subjects (age: 22±2years) underwent sensory organization test (SOT) using SMART Balance Master System. SOT evaluates postural control under 6 conditions including (1) eyes open and fixed support (EO); (2) eyes closed and fixed support (EC); (3) sway-referenced vision and fixed support (SV); (4) eyes open and sway-referenced support (SS); (5) eyes closed and sway-referenced support (ECSS); and (6) sway-referenced vision and support (SVSS). Microfet3 was used to assess neck ROM and isometric strength. Comparisons between groups were made using independent t-test. RESULTS: Equilibrium scores showed significant differences between groups in EO (94.4±1.7 vs. 95.9±1.0), SS (80.1±15.5 vs. 91.2±2.6), ECSS (57.0±16.4 vs. 70.6±4.9) and SVSS (59.7±15.1 vs. 78.7±6.3). Vis (0.8±0.2 vs. 1.0±0.02) and Vest (0.6±0.2 vs. 0.7±0.1) ratios had significant differences between groups. Neck ROM was significantly larger and isometric rotational muscle strength was also significantly stronger in the young group than the middle-aged group. CONCLUSION: Cervical spondylosis was diagnosed in the milled-aged group and might contribute to the change of neck ROM and isometric strength. ROM and strength were both deteriorated in the middle-aged group compared to the young group. Sensory ratios indicate the ability to use the visual or vestibular system and reflect in a sense the neck function. Poor balance performance in the middle-aged group may be in part attributed to poor neck function, reflected in the lower sensory ratios.

Neck Pain In A Discus Thrower

HISTORY: A 20yo female collegiate discus thrower with acute onset of shooting pain in her left neck when she abruptly extends her neck and turns it to the left. She develops simultaneous numbness on her left tongue and face. She has difficulty speaking transiently. Episodes last 20 to 30 seconds. They are followed by a left-sided headache which lasts all day. It is a shooting sensation radiating up from the neck and "feels like getting hit in the funny bone." The athlete denies any weakness or sensation deficits in extremities, seizures, dizziness, or visual changes. Symptoms began in high school but have increased in severity since she joined the collegiate discus team. Family history is negative. Negative review of systems. PHYSICAL EXAMINATION: Full range of motion in neck, with significant hyperextension. No C-spine tenderness. Negative bilateral Spurling's. Cranial nerves intact. Speech within normal limits. Sensation intact to pinprick. Normal pupillary and funduscopic exams. Reflexes are 2+ and strength 5/5 in all extremities. Coordination intact. Normal gait. Negative Rhomberg's. No clonus. Negative bilateral Babinski. DIFFERENTIAL DIAGNOSIS: Vascular insufficiency/occlusion. Transient ischemia to isolated cranial nerves. Mass compressing cranial/ cervical nerves. Nerve compression from disc hernition or spinal stenosis. TEST AND RESULTS: Laboratory testing - Normal complete blood count, erythrocyte sedimentation rate, comprehensive metabolic panel, thyroid simulating hormone. Negative anti-nuclear antibody (<1:40) and rheumatoid factor (<17). C-spine X-rays - Mild reversal of the normal cervical lordosis. 2-3mm anterolistheses of all cervical bodies C2-C6 with neck flexion, which revert to mild retrolistheses with extension. No spinal stenosis or degenerative disease. There is mild instability throughout the cervical spine. C-spine MRI - No cervical mass, disc herniation, spinal stenosis, or neuroforaminal narrowing. Brain MRI with contrast - Negative. FINAL WORKING DIAGNOSIS: Neck-Tongue Syndrome TREATMENT AND OUTCOMES: 1. Neck strengthening and postural training to stabilize neck. 2. Patient declines acetaminophen and NSAIDs. 3. She stops discus throwing without specific plans to resume it. 4. Referred to a spine surgeon. 5, Continues to follow-up with her neurologist.

The Time Course of Range of Motion Loss After Cervical Laminoplasty

A prospective study. To identify the time-dependent change in range of motion (ROM) after cervical laminoplasty. Although numerous studies have reported on the loss of flexion/extension ROM associated with laminoplasty, few have reported on the time course of this loss of motion. Twenty-three patients who received unilateral open-door laminoplasties, including miniplate fixation over 2 levels, were serially evaluated at regular set intervals after surgery. The mean follow-up period was 26.78 months (range: 24-41 months). Twelve patients had OPLL and 11 patients had cervical spondylotic myelopathy. Enrolled patients were divided into 2 groups (ossification of posterior longitudinal ligament [OPLL] and cervical spondylotic myelopathy) to compare the ROM between the OPLL and the spondylosis patients. We evaluated the time-dependent neck ROM changes by taking neutral, flexion, and extension radiographs before surgery and at 1, 3, 6, 9, 12, 18, and 24 months after surgery. Postoperative neck and arm pain was evaluated using a numerical rating scale. The preoperative, and 1-, 3-, 6-, 9-, 12-, 18-, and 24-month postoperative ROM figures were 37.8 degrees +/- 14.6 degrees, 34.1 degrees +/- 12.9 degrees, 35.0 degrees +/- 12.3 degrees, 30.3 degrees +/- 13.0 degrees, 28.6 degrees +/- 15.1 degrees, 27.3 degrees +/- 12.4 degrees, 26.1 degrees +/- 14.8 degrees, and 25.9 degrees +/- 13.2 degrees, respectively, and at the most recent follow-up, ROM was 25.8 +/- 15.2 degrees. Thus, the mean ROM decreased by 10.1 degrees +/- 9.5 degrees (31.66%) after surgery (P = 0.002). In OPLL group, we observed a more limited cervical ROM than in cervical spondylotic myelopathy group (35.3% vs. 29.2%). However, the rate of ROM reduction slowed with time in both groups (P = 0.000). Postoperative axial pain did not correlate with the degree of serial cervical ROM. The results suggest that the loss of cervical ROM is time-dependent and plateaus by 18 months after surgery, with no further decreases thereafter.

Aesthetic Reconstruction of Severe Postburn Neck Contractures

Severe neck contractures after burns cause gross facial deformity and severe functional disability. Reconstruction of these deformities is challenging. Goals of reconstruction are to obtain full range of neck movements and to restore the aesthetic appearance to the face and neck. Several methods have been described. Although all of them focus on achieving full extension and resurfacing of the neck, they often fail to restore an aesthetic contour to the neck especially in lateral profile. We present our method based on the treatment of 96 patients, with severe neck contractures operated between September 2000 and October 2005. We have successfully achieved full unlimited range of neck movements and restored a natural pleasing contour of the neck both in anterior and lateral profile. There has been no recontracture at the follow-up of 1 year.

Confiabilidade da fleximetria e goniometria na avaliação da amplitude de movimento cervical em crianças

OBJETIVO: Determinar a confiabilidade intra e interexaminadores e correlacionar os valores de amplitudes de movimentos (ADM) cervical obtidas por fleximetria e goniometria em crianças. MÉTODOS: Participaram deste estudo 106 crianças saudáveis, 49 meninos (8,91±2,09 anos) e 57 meninas (9,14±1,46 anos), com idades entre seis e 14 anos, assintomáticas para disfunção cervical. Dois examinadores previamente treinados e dois auxiliares avaliaram a ADM cervical. Os examinadores coletaram as medidas por fleximetria e goniometria (confiabilidade interexaminadores) e repetiram as avaliações, após uma semana (confiabilidade intra-examinador). Todas as medidas foram registradas três vezes por cada examinador e o valor médio foi considerado para análise estatística. O coeficiente de correlação intraclasse (ICC 2,1 e 2,2) foi utilizado para verificação das confiabilidades e o coeficiente de correlação de Pearson (p<0,05) foi utilizado para verificação da correlação entre as medidas obtidas por ambas as técnicas. RESULTADOS: Foram observadas confiabilidades intra-examinador moderado e excelente para a fleximetria e moderada para a goniometria. As confiabilidades interexaminadores foram moderada e excelente para a fleximetria e pobre e moderada para a goniometria. Foi verificada correlação significativa e pobre entre todas as medidas de ADM cervical obtida pelas técnicas estudadas, exceto para o movimento de rotação à esquerda. CONCLUSÕES: A correlação pobre entre as mensurações de ADM cervical obtidas por fleximetria e goniometria demonstram que as técnicas não apresentam medidas intercambiáveis e, como a fleximetria apresentou maiores níveis de confiabilidade para avaliação da ADM cervical em crianças, seu uso é recomendado em relação à goniometria.

Range of Motion of the Cervical Spine in Adult Rugby Athletes Compared to Non-Athletes

H and neck range of motion is a measure of functional status as well as an assessment of anatomical pathology and can be used as an indication of dysfunction in the cervical spine. Veteran rugby athletes have shown spinal degeneration in previous studies, although few have measured range of motion. PURPOSE: The purposes of our study were to measure cervical ranges of motion and compare our results between rugby athletes and non-athletes. METHODS: Our study recruited nineteen adult rugby athletes and ten non-athletes from the Quad Cities area, with a mean age of 27.3 years [27.3 (3.15)]. Using electromagnetic sensors, we collected gross and coupled cervical range of motion data in three planes. RESULTS: The intraobserver test-retest reliability of our system and study procedures were found reliable for measuring full-cycle (ICC = 0.75, 0.93, 0.72) and total cervical range of motion measurements (ICC = 0.82). Borderline significant differences between groups were found between rugby athletes and non-athletes in right lateral bending; (P= 0.07); rugby athletes demonstrated decreased ranges of motion when compared to non-athletes. CONCLUSIONS: Observed differences in the ranges of motion, although not statistically significant, may be a result of strenuous athletic activity and may play an important role in future morbidity. This investigation was conducted in a facility constructed with support from Research Facilities Improvement Program Grant Number C06 RR15433-01 from the National Center for Research Resources, National Institute of Health.

Torticollis, facial asymmetry and plagiocephaly in normal newborns

Objective: To evaluate the incidence and characteristics of torticollis, plagiocephaly and facial asymmetry in normal newborn infants. Design: 102 healthy newborn infants were examined prospectively during their birth hospitalisation for...

Congenital Head and Neck Asymmetry Is Common and Often Unrecognized

The Back to Sleep campaign encourages the supine sleep position during infancy, but this practice might be associated with an increasing incidence of posterior cranial deformations. To examine the incidence of and characteristics associated with congenital cranial deformation, investigators prospectively examined neck range of motion and torticollis, plagiocephaly, and facial …

Acupuncture Needling versus Lidocaine Injection of Trigger Points in Myofascial Pain Syndrome in Elderly Patients – a Randomised Trial

To compare the efficacy of acupuncture needling and 0.5% lidocaine injection of trigger points in myofascial pain syndrome of elderly patients. Thirty nine participants with myofascial pain syndrome of one or both upper trapezius muscles were randomised to treatment with either acupuncture needling (n=18) or 0.5% lidocaine injection (n=21) at all the trigger points on days 0, 7 and 14, in a single-blinded study. Pain scores, range of neck movement, pressure pain intensity and depression were measured up to four weeks from the first treatment. Local twitch responses were elicited at least once in 94.9% of all subjects. Both groups improved, but there was no significant difference in reduction of pain in the two groups at any time point up to one month. Overall, the range of cervical movement improved in both groups, apart from extension in the acupuncture needling group. Changes in depression showed only trends. There was no significant difference between acupuncture needling and 0.5% lidocaine injection of trigger points for treating myofascial pain syndrome in elderly patients.

Laminoplasty and Skip Laminectomy for Cervical Compressive Myelopathy

A prospective randomized clinical trial in surgical treatment for cervical compressive myelopathy. We prospectively compared modified laminoplasty and skip laminectomy in terms of surgical invasiveness, postoperative range of cervical motion, axial pain, and surgical outcomes. Laminoplasty is an established procedure for the decompression of multisegmental cervical compressive myelopathy. However, it often induces postoperative problems, such as axial pain, restriction of neck motion, and loss of lordotic alignment. Skip laminectomy was recently developed as a minimally invasive procedure. Forty-one patients with cervical spondylotic myelopathy (CSM), excluding developmental stenosis, were randomized to modified double-door laminoplasty (Lamino group; n = 21) or skip laminectomy (Skip group; n = 20), and followed for more than 1 year (average, 28.1 months). Of these patients, radiographs were taken in neutral, extension, and flexion positions before surgery and after surgery. The cervical alignment of C2-C7 curvature and range of motion (ROM) were calculated. After surgery patients were asked to rate their neck pain, using the visual analogue scale (VAS) periodically. Clinical outcomes were estimated with the Japanese Orthopedic Association scoring system (JOA score). There was no significant difference about operative time and blood loss between Lamino and Skip groups. The C2-C7 lordosis of neutral position in both groups was decreased by a few degrees at final follow-up. The final ROMs were 77.4/88.6% of preoperative ROM, respectively. At all collection times, no significant difference in VAS score of axial pain was seen in either group. There was no significant difference in JOA score between both groups before and after surgery. No significant differences were seen between Lamino and Skip groups, in terms of operative invasiveness, axial neck pain, cervical alignment, and ROM, and clinical results in the patients of CSM without developmental stenosis.

Cervical range of motion and proprioception in rugby players versus non-rugby players

In this study, we examined the effects of number of years of playing rugby on neck function. Active cervical spine range of motion and proprioception were assessed in 14 non-rugby-playing but trained sportsmen (mean age 28 years, s = 7) and 46 rugby players (26 rugby forwards: mean age 26 years, s = 5; mean years played 14 years; 20 backs: mean age 24 years, s = 5; mean years played 14 years). Active cervical range of motion in flexion, extension, left and right lateral flexion, plus left and right rotation were measured using a cervical range of motion device. The ability to reposition the head in a central position with eyes closed was taken as a measure of proprioception. Results show that rugby forwards generally had the least active cervical range of motion, particularly neck extension (forwards, 43°; backs, 55°; controls, 58°), with the decrement correlating with the number of years played. In addition, repositioning was significantly worse in rugby players after neck extension than non-rugby players (6° vs. 3°). The active cervical range of motion of rugby forwards is similar to that of whiplash patients, suggesting that participation in rugby can have an effect on neck range of motion that is equivalent to chronic disability. Reduced active cervical range of motion could also increase the likelihood of injury and exacerbate age-related neck problems.

Surgical revision of congenital muscular torticollis in an adult male with established facial asymmetry

BACKGROUND: We present the case of a 36-year-old male patient with congenital muscular torticollis in whom surgery performed twice to treat the condition in early childhood had failed. METHODS: Scar tissue, fibrous cord, the deep neck fascia together with the rest of the SCM muscle were resected. Postoperatively, the patient wore a collar and underwent intensive physical therapy. RESULTS: The patient showed marked improvement in range of neck motion and head tilt, experienced pain relief, achieved satisfactory functional and cosmetic results and had a better quality of life. CONCLUSIONS: We suggest that even in an adult with irreversible facial and cranial deformities, surgery would be beneficial for improving quality of life by restoring range of rotation of neck and amelioration of pain.

Unilateral cervical nerve injuries: Brachial plexopathies

Brachial plexus injuries are frequently encountered in sports. Classically, the symptoms include transient burning, pain, and occasionally weakness of an isolated upper extremity resulting from a peripheral nerve injury of varying degrees. Persistent symptoms or recurrent injuries may necessitate imaging such as electromyography. Medical personnel should be familiar with brachial plexus anatomy and the common nerve injury mechanisms of compression or traction. On-field assessment includes evaluation for potentially more serious neurologic injuries and possible return to play when symptoms have resolved and the athlete has good range of motion and strength. Evidence-based guidelines are largely lacking, resulting in challenging evaluation and return-to-play decisions. Management focuses on improving neck range of motion and strength in addition to assessing for proper sport-specific technique. Additionally, enhancing protective equipment may prevent brachial plexus injuries. Currently, global screening via imaging of athletes is not recommended.

Clinical Characteristics of Swallowing Disorders Caused by Cerebrovascular Disease: A Study Using Newly-developed Indices for the Basic Elements of Swallowing Movement and Neck Range of Motion.

The objective of this study was to elucidate the characteristics of swallowing disorder in cerebrovascular disease (CVD) patients in terms of newly developed indices for the basic elements of swallowing movement and muscle tone in the neck. A total of 133 patients participated in our study, 116 patients with CVD and 17 elderly patients who had no history of dysphagia and CVD. These patients were divided into 5 groups according to the existence of swallowing disorder and interval from onset. The effects of CVD and swallowing disorder were elucidated by two-group comparison. Measurement items consisted of and passive neck ROM in 4 directions (flexion, extension, lateral flexion, and rotation.) 5 newly developed indices: distance from the genion to the upper end of thyroid cartilage (GT), distance from the upper end of thyroid cartilage to the upper end of sternum (TS), length of the suprahyoid and infrahyoid muscles on neck extension (GT+TS), relative larynx position (GT/(GT+TS)), and strength of the suprahyoid muscles (GS grade). Patients with CVD of less than 90 days' duration exhibited GT shortening, decline in GS grade, and limitations in neck extension and rotation ROM. In the chronic phase, TS shortening, laryngeal lowering, and limitations in neck flexion and lateral flexion ROM were observed. Physical therapists should aim to improve the factors that might impede laryngeal movement and to conduct preparatory exercises that facilitate swallowing movements.

Clinical Effects of Fluoroscopy Guided Interventional Microadhesiolysis and Nerve Stimulation (FIMS) on Cervical Zygapophyseal Joints in Patients with Chronic Cervical Radicular Pain

Background: Cervical radicular pain can arise fromvarious structures, including spinal nerves, discs, zygapophyseal joints, ligaments, and myofascial connective tissue. However, no adequate experiments have been found regarding methods for the microadhesiolysis of adhesional connective tissue around the zygapophyseal joints and nerves. The first objective of this study was to ascertain the effect of fluoroscopy guided interventional microadhesiolysis and nerve stimulation (FIMS) on chronic cervical radicular pain caused by zygapophyseal joint dysfunction. The second objective was to identify the duration of pain alleviation, as well as commonly occurring regions for zygapophyseal joint dysfunction. Methods: Twenty-eight patients were diagnosed with cervical radicular pain. The cervical zygapophyseal joints and adhesional structures around the cervical zygapophyseal joints were stimulated by adhesiolysis with a rounded needle; the procedure was performed once every second week. A visual analogue scale (VAS) for pain and neck range of motion (ROM) were used as indices for evaluating the degree of pain 1 and 3 months after completion of the procedures. A relief effect of FIMS was accepted when the VAS index decreased 50% compared with a previous VAS, and when there was absence of limitation of ROM. Results: Among the patients, 52% showed zygapophyseal joint dysfunction in C5-6, 38% in C4-5, 7% in C2-3, and 3% in C6-7. After performing FIMS, the VAS index decreased in most of the patients after 1 and 3 months (92.8% and 75%, respectively), and treatment frequency was 2.7 ± 1.2. There was no correlation between the number of FIMS procedures and the degree of VAS. Conclusions: FIMS is considered an effective modality in patients suffering from cervical radicular pain. (Korean J Pain 2007; 20: 31-39)

Comment on: Difficult Airway Due To Large Scalp Swelling In Occipital Region

It is not clear from the letter whether the difficulty was predicted for ventilation and intubation other than the presence of the huge occipital swelling i.e a higher Mallampatti class or a shorter thyromental distance etc. Although patient had a large occipital mass, the gap between the swelling and the neck probably allowed some range of neck movement. We appreciate the fact that huge occipital swelling can cause difficulty in securing an airway.

Cervical radiculopathy vs Parsonage-Turner syndrome: a case report.

Case reportA 42-year-old recreational cyclist presented with a 3-month history of right-sided neck pain. The patientexperienced pain radiating to the right periscapular regionand paresthesias in digits 1–3. The onset of the pain wassudden. She described the pain as intermittent and sharp,ranging from 8–10/10 on numeric pain rating scale. Thepain was worse at nighttime, often so severe that it wouldwake her from sleep. She also noted severe headaches andright upper extremity numbness and weakness. She hadvisited the emergency room twice, both times beingadmitted to a neurology service because of the severenature of the pain and what was described as atypicalhemiplegia and migraines. A CT scan of the head andcervical spine and an MRI of the cervical spine werenormal. The patient was discharged on pain medication,which included prednisone, depakote, zoloft, motrin, andtopamax. There was no history of trauma, falls, or anyinciting events. She had no history of bowel or bladderincontinence, recent travel, or fever and chills. Her medicalhistory was significant for migraines, right carpal tunnelsyndrome, and depression. She was taking lexapro andclonazepam for depression.Physical examination revealed mild limited cervicalrange of motion with end range axial pain with flexion,extension, and lateral rotation. Spurling maneuver waspositive on the right side eliciting pain in digits 1 and 2.Active and passive range of motion of the right shoulderwas minimally limited compared to the left (asymptomatic)side. Additional findings included medial winging of theright scapula and mild weakness (4+/5) of the right triceps.Muscle strength throughout the rest of the upper extrem-ities was 5/5. The rest of the physical examination revealednormal muscle bulk and tone, normal sensation, symmetricupper extremity reflexes, and negative Hawkins_, Neer_s,Roos_, Wright_s, and Adson_s provocative tests.Clinical evaluation at this point was suggestive ofParsonage–Turner syndrome vs a cervical radiculopathy,although a broader differential diagnosis was considered(Fig. 1). Electrodiagnostic studies were performed andshowed evidence of severe denervation (2+ positive sharpwaves and fibs) corresponding to muscles of the right C7myotome and including the paraspinal muscles, consistentwith a right C7 radiculopathy (Fig. 2). Motor unitrecruitment was reduced in the involved muscles and therewere no polyphasic potentials. An MRI of the cervicalspine was repeated and revealed mid to lower cervicalspondylosis, moderate left-sided C5/6 foraminal stenosis,and mild right-sided C6/7 foraminal stenosis (Fig. 3).Because the MRI findings did not demonstrate significantnerve root compression, the patient was diagnosed withParsonage–Turner syndrome and Lyrica was prescribed.Over the next 6 weeks the patient_s symptoms improvedbut then suddenly worsened.The patient returned for follow-up with complaints ofrecurrent right neck pain and right upper extremityweakness. Neck range of motion was now normal andSpurling_s maneuver was now negative. There was greaterupper right extremity weakness, with motor strength ofright triceps 4+/5, right wrist extension 4j/5, and rightwrist flexion 4/5. Reflexes were normal and sensation wasintact. Parsonage–Turner syndrome was still the workingdiagnosis and the patient was referred to physical therapyto treat a superimposed cervical radicular component.Over the next 2 months, the patient continued to havesymptoms and developed a shingles-like rash on herbuttock. She was treated by her primary care physicianwith Valtrex and within a few days the patient_s neck andright arm pain completely resolved. One month later, shehad recurrence of the buttock rash along with return of theneck and arm pain. She again received a course of Valtrexand her symptoms completely resolved. To date, 1 yearlater, she has been pain-free with almost full strength andable to return to all previous activities, including recrea-tional cycling.DiscussionEvaluation of the patient with neck and unilateral arm paincan present a diagnostic and treatment challenge. Anatomic