Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 178: A 57-Year-Old with Neck Pain
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Jan 8, 2026 Dive into the complex world of neck pain with a case study of a 57-year-old patient. Explore crucial red flags that could indicate serious underlying issues. Learn about the Spurling maneuver and its significance in diagnosis. Differentiate cervical radiculopathy from more severe conditions like infections and metastasis. Discover the importance of imaging techniques like X-rays and MRIs. Finally, discuss various management strategies from conservative care to surgical options. Tune in for insights on assessing acute neck pain!
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Real Patient Case: Work-Related Neck Pain
- The patient is a 57-year-old computer analyst with chronic right-sided neck pain now radiating to her arm and middle finger numbness.
- Symptoms worsen by end of day and improve with rest, and ibuprofen provides partial relief.
Cancer History And Positive Spurling Finding
- The patient had stage I ER+ breast cancer treated with surgery, radiation, and ongoing aromatase inhibitor therapy.
- Exam showed pain-limited right neck rotation, positive Spurling maneuver, normal strength, and diminished right triceps reflex.
Evaluation Should Rule Out Dangerous Causes
- When evaluating neck pain, prioritize identifying neuropathic components and recognizing dangerous causes like infection, malignancy, or spinal cord involvement.
- A focused history and exam guide whether further imaging or urgent intervention is needed.
