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Published byBritney Sharp Modified over 9 years ago
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This is a case of M.T, 37 year-old female, married, Christian, right-handed, from Malate, Manila who came in due to stiffening and pain in the neck.
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Patient is a non-diabetic, non-hypertensive. Few months PTC – on and off nape pain, described as piercing, radiating to shoulder area with pin-prick sensation. 4/10 on VAS. Resolves spontaneously. No history of trauma. No meds taken. No consult done.
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1 day PTC – after bout of prolonged coughing, noted the same nape pain (piercing in character), which radiates to the rest of the head and shoulder (pin-prick in character), 6/10 on VAS, associated with slight stiffening of the neck, (+) some degree of limitation of range of motion of the neck due to pain. At day of consult – persistence of stiffening and pain of neck area prompted consult.
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(-) fever/weight loss/easy fatigability/ no loss of appetite (-) dizziness (-) cough/colds/difficulty of breathing (-) chest pain/palpitations (-) abdominal pain/diarrhea/change in bowel movement/melena,/hematochezia/hematemesis (-) dysuria/polyuria/ polydipsia/polyphagia (-) loss of consciousness/seizures
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(+) Endometriosis with adenomyosis – maintained on DMPA (-) HPN, (-) DM, (-) PTB, (-) BA (-) previous hospitalization (-) previous operation (-) allergy to food and drugs
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College graduate Works as a teacher No vices
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conscious, coherent, in pain (6-7/10 on VAS) Vital Signs: BP= 120/70mmhgHR=96 bpm RR=20cpmT= 37 CBMI= 22 kg/m 2 HEENT: anicteric sclerae, pink palpebral conjunctivae, (-) cervicolympadenopathy, (-) tonsillopharyngeal congestion
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CHEST: equal chest expansion, no retraction, clear breath sounds, (-) crackles CVS: adynamic precordium, distinct heart sounds, normal rate regular rhythm, no murmur ABDOMEN: flat, normoactive bowel sounds, nontender EXTREMITIES: full and equal pulses, no cyanosis, no edema (+) direct tenderness on neck and shoulder area (+) limitation of flexion, extension, rotation of the neck on passive and active motion
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Neuro Exam: GCS 15, oriented to 3 spheres CN I: NA CN II: 2-3 mm EBRTL CN III, IV, VI: full EOMS CN V: (+) corneal reflex CN VII: (-) facial asymmetry CN VIII: gross hearing intact CN IX, X: (+) gag reflex CN XI: good shrug CN XII: tongue midline Motor: 5/5 on all Extremities Sensory: 100% light touch on all extremities Cerebellar: (-) dysdiadokinesia DTR’s: ++
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Myofascial Pain Syndrome, cervical area r/o Cervical Radiculopathy Endometriosis with Adenomyosis
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Dx: Cervical AP-L Tx: 1. Eperisone HCl 50mg/tab 1 tab TID 2. Mefenamic Acid 500mg q8 PRN for pain Warm Compress on cervical area Avoid sudden movement of neck
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In adult patients presenting with localized pain and stiffness of the neck, what is the sensitivity and specificity of x-ray vs MRI in diagnosing Cervical Radiculopathy, using a cross sectional study?
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PopulationAdult patients presenting with localized pain and tenderness of the neck InterventionX-ray vs MRI OutcomeSensitivity and specificity in diagnosing Cervical Radiculopathy MethodCross sectional study
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In adult patients diagnosed with Myofascial Pain Syndrome, is Eperisone + NSAID more effective than Baclofen + NSAID in achieving faster relief of spasticity, using randomized control trial
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PopulationAdult patients diagnosed with Myofascial Pain Syndrome InterventionEperisone + NSAID ComparisonBaclofen + NSAID OutcomeFaster relief of spasticity MethodRandomized control trial
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Thank you!
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