Hi all,

Have started seeing a patient recently (privately) and could do with some peer support / ideas as I'm not 100% what is going on. Basically, he's a 21 year old male with a 5 year history of neck pain following an injury in rugby. He can't remember what happened, just that he went down in a scrum, didn't think he lost consciousness. Went to his GP and was checked over - gave it a bit of relative rest and it had improved quite a lot although he hadn't gone back to playing rugby.

Initial onset pain was R-sided anterior shoulder and up back of neck, with what he describes as a "pulsing, hard tennis ball" at the back of his neck (?muscle spasm) and L-sided neck and pain in upper traps. It seemed things were improving although he got intermittent pain on and off depending on activity (he does a very manual and varied job). 2 years ago he had a nasty car accident - aquaplaned at 80mph and rolled the car. Went to A&E and had x-rays - all came back clear and was diagnosed with whiplash associated disorder/soft tissue injury.

It seems his neck pain has been worse since this, although in further questioning he can't really give any further info. The pain is still intermittent, he can't identify any specific aggs other than it comes on gradually throughout the day, always worse in the evening and depends on how much work he is doing. He tried to return to rugby in November (he also had further x-rays done at this time when he saw GP, which came back NAD again) 2011 but was unable due to pain. Saw the pitch side physio who gave him some neck exercises / thoracic extensions (from what he described) but these didn't help either.

On examination, he has no red flags / 5 D's. No P+N or numbness and slight increased neural tension in his right arm on testing with a radial bias. His shoulder ROM is full in all directions and asymptomatic. His neck ROM is full in all directions and asymptomatic (both passively and actively). He has very tight upper traps bilaterally and tight pecs R>L. Dermatomes and myotomes are all normal. No objective tests brought on any symptoms.

I've given him general neck exercises and retractions to regularly, advice on posture and pec/upper traps stretches to do for now.

I was just wondering does anyone else have any ideas as to what could be the problem? My initial [tentative] diagnosis is chronic neck pain due to this old rugby injury, ?scar tissue, which has been aggravated by the car accident. I'm not sure if there's a discal element to his symptoms...any advice or further opinions would be much appreciated!

Thanks,

Fi.

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