Pain in the neck

[Gajba]

Patient, 27 years old.
Pain in the left occipital region. All movements in the neck are painful with decreased ROM. Very painful on palpation atlanto-occipital and atlanto-axial joints.
Symptoms last for 2 weeks. Worse in the night, one night pain in the left half of the head from the occipital region to the front of the head with nausea.

On the first treatment - gently traction, massage, laser, and lateral flexion to the left (removed pain). Posture instructions (for sleep).

Two days better then one night worse.

Second treatment - no pain in the left half of the head, but still very painful on the palpation. Mobilization in lateral flexion, traction, massage, laser.
In the night and morning worse.

Any ideas?

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[binmath]

hi friend,
is there any history of significant trauma to the part?occipital nerve compression ya basilar artery compression might be differential diagnosis.if muscle spasm of suboccipital musceles is present try suboccipital myofascial release

[Gajba]

Hi Binmath,

Patient did not have any trauma on the neck.
I will reconsider differential diagnosis.
Could you describe a technique of suboccipital myofascial release or give me some useful link?

Thank you!

[neurospast]

Gaiba, it seems to me that if on 1 ocassion you have a positive result and at the 2nd ocassion a negative that there is a possibility of a trapped nerve as binmath suggested. at least something is trapped (likely in between C0-C1) otherwise you would have had twice the same response. (Or the cause is non biological)
What I would like to know is : what sort of pain, referred pain where referred pain. How about posture of cervical spine/ head and in general. Mobility of spine, antalgic posture.
The information you supplied is not enough to diagnose.
on your second question: A way to mobilize could be by giving the patient a resistance (F2 on a scale of 5 as if you meassure musclestrength) against the direction you want him to move his head e.g. rotation to the right you give a slight resistance on the right cheeck (in lying) with the other hand you can palpate than all the vertebrae to see which one doesn't move.

[sdkashif]

Have a look over the differential diagnosis and recheck your diagnosis

Mechanical etiologies

Cervical stenosis
Cervical zygapophyseal (facet) arthropathy
Cervical disc syndrome
Cervical Spondylosis
Cervical Sprain and strain
Cervical Myofascial pain syndrome
Fibromyalgia
Thoracic outlet syndrome

Infectious etiologies

Discitis
Epidural, subdural, or intradural abscess

Metabolic etiologies

Osteomalacia
Parathyroid disease
Osteoporosis (Primary and secondary)

Rheumatologic etiologies

Polymyalgia rheumatica
Ankylosing spondylitis
Reiter syndrome
Enteropathic arthritis
Diffuse idiopathic skeletal hyperostosis
Osteoarthritis
Rheumatoid Arthritis

CNS Disorders

Traumatic Brain Injury
Brown Sequard Syndrome
Central cord Syndrome
Brachial Neuritis
Occipital neuralgia as a result of spondylotic changes at C1-C2
Primary spinal cord tumors
Syringomyelia
Extramedullary lesions - Tumors and thoracic disk herniation
Normal pressure hydrocephalus
Spinal cord infarction
Spinal sepsis
Whiplash syndrome - Hyperextension-hyperflexion injury
Pancoast tumors
Double crush syndrome - Coexistence of a radiculopathy and peripheral nerve compression in the carpal or cubital tunnel

Others

Malingering
Psychogenic pain disorder
Referred pain from cardiothoracic structures
Tumor or malignancy of cervical spine
Vascular abnormality of cervical structures