I saw a woman in my office today which was a very interesting case. She is a 45y/o ER nurse, and when she was a teenager, had a oropharyngeal cancer which was treated with XRT (for those of you young-un's that is cobalt beam XRT) to the head and neck. She was treated for cure.
5 years ago she began to have intermittent neck pain, and when I saw her 4 weeks ago, had significant atrophy of the posterior strap muscles of the neck, atrophy of the SCM, Trapezius, and obviously a marked head forward position.
EMG showed widespread, small fibs and PSW most concentrated in the SCM, Traps, and scalenes,but also in the limb muscles of both arms. Myokymia was present electrically in a patchy distribution (but no visible myokymia on PE).
I did an MRI (a 3T magnet) which only showed MILD DDD worst at C6 and C7, but widely patent neuroforamina and no central stenosis. There was no myelomalacia.
She is not interested in medications, so I am just sending her to PT for a progressive strengthening and stretching program and scapular stabilization (as possible). What else would you guys/gals do?
5 years ago she began to have intermittent neck pain, and when I saw her 4 weeks ago, had significant atrophy of the posterior strap muscles of the neck, atrophy of the SCM, Trapezius, and obviously a marked head forward position.
EMG showed widespread, small fibs and PSW most concentrated in the SCM, Traps, and scalenes,but also in the limb muscles of both arms. Myokymia was present electrically in a patchy distribution (but no visible myokymia on PE).
I did an MRI (a 3T magnet) which only showed MILD DDD worst at C6 and C7, but widely patent neuroforamina and no central stenosis. There was no myelomalacia.
She is not interested in medications, so I am just sending her to PT for a progressive strengthening and stretching program and scapular stabilization (as possible). What else would you guys/gals do?