123: IDIOPATHIC NECK PAIN

PATIENT PRESENTATION

A 38-year-old female dental hygienist presents with complaints of neck pain with insidious onset 3 weeks ago. She reports she has pain while working on her dental patients and the pain gets worse throughout the day. She rates her pain at 8/10 at its worst. Her pain subsides with rest to a 3/10. She reports having approximately three to four headaches per week that typically arise in the middle of her workday. She also notes she is a very active cyclist and competes in many local races throughout the year.

Her primary care physician in order to evaluate and treat refers her for physical therapy. Physical therapy examination revealed decreased range of motion (ROM) in bilateral cervical rotation and cervical lateral flexion. Cervical and thoracic joint mobility was normal. On palpation, muscle tenderness was noted in the upper trapezius, sternocleidomastoid, scalene, and levator scapulae muscles bilaterally. She also has two active trigger points: one in her right upper trapezius and one in her right levator scapulae. Spurling test and upper limb nerve tension tests were negative for the reproduction of symptoms. There are no signs of muscle atrophy. Manual muscle testing revealed strength 4-/5 for bilateral shoulder elevation, 3/5 for scapular retraction, 3/5 for right cervical lateral flexion, 3+/5 for left cervical lateral flexion, and 3/5 for bilateral cervical rotation.