Case Vignette Neck Pain with Arm pain
Given the following
Patient Profile: 39 y/o brokerage firm secretary with insidious onset of cervical spine (CS) pain 4 weeks ago. She indicates that it began to resolve after 2 weeks & became a low grade dull ache however she has developed left upper extremity (LUE) pain since that time which has now driven her to seek help. She has seen no one else for care.
Chief Complaint Of (C/C/O):
LUE descending from posterior arm to ulnar border of the forearm & to the 4th & 5th digit. When this is at it’s worst she cannot use the arm without further increase of both the UE symptoms & the CS pain. The UE pain was formerly erratic but is happening more frequently, and has increased from 2/10 to 8/10 in NPRS. She feels that she cannot fully extend her elbow in reaching activity without increasing the UE pain
Secondary C/O: Constant L sided CS pain localized at lower cervical segments. This is the most consistent complaint. Described as low-grade constant ache in the neck (1/10), episodic elevation to 5. When it worsens it will lead to L UE pain in posterior UE & ulnar border of forearm.
Agg-Ease Factors
UE: Intermittent, when it presents it goes from 2-8 quickly, aggravated by pushing, pulling or lifting within 5 minutes, she has to stop the activity immediately. She gets the same response from looking directly up at the overhead market monitors which brings on her UE pain within 1 minute. The symptoms settle over 4 hours with supine positioning, ice & OTC analgesics. She has had to stop the activity.
CS pain:
Driving provokes neck pain after more than 1 hour from 1-4, if she stops it will cease climbing & settle back to near baseline in 15 minutes. Working with UE in desktop reaching activities longer than 1 hour increase the neck pain from 1- 5. It settles to 2 within minutes of ceasing, & to 1 in 15 minutes. Lifting heavy objects (> 20 # ) gives immediate neck pain to 5/10, and UE pain at a 5-6. Setting the object to rest the neck begins to settle immediately, but the arm pain may require 15-20 minutes.