OBJECTIVE: The purpose of this report is to describe the evaluation and treatment of a patient initially presenting for chiropractic care of neck pain (NP) who was subsequently diagnosed with retropharyngeal calcific tendonitis (RCT). CLINICAL FEATURES: A 53-year-old woman presented to a chiropractic office with severe idiopathic NP, loss of cervical mobility, and intermittent painful swallowing. She had a motor vehicle accident 6 months before with NP that resolved within a week without treatment. A brief examination and some manual palliative care were attempted by the chiropractor. Two days later, the patient developed severe NP and fever, sought emergency medical care on her own, and requested the chiropractor meet her at the hospital. The emergency physicians initially considered an infection, and antibiotics were provided along with oxycodone and naproxen sodium for pain. After advanced (computed tomography) imaging, RCT was diagnosed, and she was discharged the next day. INTERVENTIONS AND OUTCOME: After being diagnosed, the patient's primary care provider prescribed prednisone and physical therapy. After 3 weeks, the patient stated her pain continued and she went for chiropractic care and was treated for mechanical neck pain with manipulation, manual muscle treatment, postural training, and rehabilitative exercises. CONCLUSION: Practitioners should recognize the clinical presentation of RCT, order appropriate computed tomography imaging, and implement effective treatments. Although uncommon, RCT should be considered in patients with NP, limited mobility, and painful swallowing.
OBJECTIVE: The purpose of this report is to describe the evaluation and treatment of a patient initially presenting for chiropractic care of neck pain (NP) who was subsequently diagnosed with retropharyngeal calcific tendonitis (RCT). CLINICAL FEATURES: A 53-year-old woman presented to a chiropractic office with severe idiopathic NP, loss of cervical mobility, and intermittent painful swallowing. She had a motor vehicle accident 6 months before with NP that resolved within a week without treatment. A brief examination and some manual palliative care were attempted by the chiropractor. Two days later, the patient developed severe NP and fever, sought emergency medical care on her own, and requested the chiropractor meet her at the hospital. The emergency physicians initially considered an infection, and antibiotics were provided along with oxycodone and naproxen sodium for pain. After advanced (computed tomography) imaging, RCT was diagnosed, and she was discharged the next day. INTERVENTIONS AND OUTCOME: After being diagnosed, the patient's primary care provider prescribed prednisone and physical therapy. After 3 weeks, the patient stated her pain continued and she went for chiropractic care and was treated for mechanical neck pain with manipulation, manual muscle treatment, postural training, and rehabilitative exercises. CONCLUSION: Practitioners should recognize the clinical presentation of RCT, order appropriate computed tomography imaging, and implement effective treatments. Although uncommon, RCT should be considered in patients with NP, limited mobility, and painful swallowing.
Authors: Rhea Victoria B Razon; Asad Nasir; George S Wu; Manal Soliman; Jeffrey Trilling Journal: J Am Board Fam Med Date: 2009 Jan-Feb Impact factor: 2.657