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My neck hurts

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A 71 y/o male calls due to progressively worsening neck pain over the last 24 hours. He is unable to move his neck due to the pain. He has no medical history, surgical history or allergies. He takes no meds on a regular basis but has been taking some motrin for the pain with some relief.

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what physical activity was he doing the day or two before the pain started?

where specifically is the pain centered ? structural or muscular?

any vision or speech issues?

as always vitals and full exam

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what physical activity was he doing the day or two before the pain started?

where specifically is the pain centered ? structural or muscular?

any vision or speech issues?

as always vitals and full exam

He was shoveling snow earlier in the day but doesn't recall any injuries or pain. He points to the area of C4 down to C7 as the area of pain. No vision or speech issues. HR 80, BP 148/88, RR 14 SPO2 99% on room air. The pt has pain with palpation to the area where he says it hurts. No step offs. There is a 4" by 3" red area centered over the painful area with a broken blister to the left side measuring about 1 cm by 3 cm. He tells you it is from a hot rice pack his wife made him for the pain.

Clearly ebola. Run away.

Close, but it is actually herpegonosyphilitis.

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He was shoveling snow earlier in the day but doesn't recall any injuries or pain. He points to the area of C4 down to C7 as the area of pain. No vision or speech issues. HR 80, BP 148/88, RR 14 SPO2 99% on room air. The pt has pain with palpation to the area where he says it hurts. No step offs. There is a 4" by 3" red area centered over the painful area with a broken blister to the left side measuring about 1 cm by 3 cm. He tells you it is from a hot rice pack his wife made him for the pain.

How hot was the rice pack and how long did he have it on? If he really burned himself that badly it was either very hot or he has a problem with the tissue in his neck, localized paralysis, degenerative disease of some sort or something along those line. Or...the pain is just due to the burn and this is all a red herring...

Could be a spider bite as well if that's a problem in that part of the country.

Close, but it is actually herpegonosyphilitis.

Hell I've had that four times now...no big deal there.

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At 71 he shouldn't be shoveling snow. How much snow & for how long?

Is he having muscular contractions or spasms in his neck or shoulders?

how are the tendons in his neck soft & pliable or taut?

My gut is going with muscoskeletal strain , but to be sure I think further checking is needed.

How deep is the burn? 2nd or 3rd degree?

sounds like she nuked the rice bag and didn't test it to see how hot it was before wrapping it on his neck.

I had a good friend who thought she could shovel 5 inches of heavy wet snow off her flat roof. She ended up with a slipped disc C-4/C-5 and is still in pain 2 months later with partial impingement of the spinal cord, partial loss of function of her right arm with numbness & tingling.

surgeons want to operate to relieve the pressure to the cord.

Edited by island emt

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How hot was the rice pack and how long did he have it on? If he really burned himself that badly it was either very hot or he has a problem with the tissue in his neck, localized paralysis, degenerative disease of some sort or something along those line. Or...the pain is just due to the burn and this is all a red herring...

He said it was pretty hot and burned when she put it on. He thought about taking it off but wanted relief from he pain that was present before the burn

Could be a spider bite as well if that's a problem in that part of the country.

No, it's not MRSA

At 71 he shouldn't be shoveling snow. How much snow & for how long?

He shoveled his driveway which took him about an hour.

Is he having muscular contractions or spasms in his neck or shoulders?

Nope

how are the tendons in his neck soft & pliable or taut?

Normal for a 71y/o

My gut is going with muscoskeletal strain , but to be sure I think further checking is needed.

How deep is the burn? 2nd or 3rd degree?

Mostly 1st degree with the 1cm by 3cm area of 2nd degree

sounds like she nuked the rice bag and didn't test it to see how hot it was before wrapping it on his neck.

Sounds about right

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Is there a particular movement that hurts worse than others?

How about moving other parts of the body; shrugging his shoulders, pushing/pulling with his arms?

It really sounds more muscoloskeletal; if he is either tough enough that he didn't care that the rice pack was hot enough to burn him that badly, OR he is just losing some sensation due to his age/a previously undiagnosed neuro disorder it wouldn't be unlikely for him to over exert himself and cause some damage.

If the motrin hasn't been working offer him something stronger; toradol, fentanyl, valium and such, transport him in the most comfortable position and ask that he keep his head still (shouldn't be a problem I'd guess) to the ER for some x-rays and maybe a CT down the road.

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Any movement hurts and when you stand to his side, he will only turn his eyes to look at you. Movement of either shoulder also hurts. He's a rural farmer so he is pretty tough. IV toradol offers him some relief. C-spine xrays are normal but he is still painful.

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Really, unless more findings pop up, either neurological deficits, tissue damage, increasing pain or further symptoms, probably start by treating it as muscoloskeletal. Prescription for some pain relievers and maybe a soft-collar to remind him to keep movement to a minimum. Seeing a physical therapist wouldn't hurt I suppose. If the pain persists or things change he needs to follow up on that but for now...

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