Hi I'm after some pearls of wisdom. I saw a 49 year old lady on Friday 2 days ago. She was co shoulder pain R medial border scapula with some clunking acute onset about a week ago and had not been exercising since. Fit and well but cervical Ca and radical hysterectomy about 18/12 with 4/12 check ups and all clear so far. Had SAD in left shoulder previously. Nothing of note shoulder wise except slight clunk in resisted abd and minor loss of strength both sides on int rot. Symptoms replicated by cervical rom. Very limited cx rom no neural or cad s&s present. Tender C5-6 centrally and both TPs. Did some gentle mulligan mobs which improved the ranges I was working on no ill effect. Palpated first rib which was tender as was trigger point med border of scapula. Mainly an ax session so very limited Rx. On finishing she had a vaso vagal episode. Paramedics attended no issues for concern and not admitted to hospital. It was a warm day and she had said she was working hard and felt tension esp in her shoulders. She felt tired and unwell following vaso vagal slightly better Saturday and improving again today but has needed lots of rest. On Saturday she said her neck and shoulder felt much less tense. Today she has severe neck pain. I have educated on red flag symptoms and still no neural or cad s and s etc. Any ideas or similar experiences? I've advised to seek medical help if any red flags appear. Should I be referring her GP?

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