A Case Of Sudden Onset Neck Pain In A Healthy Young Male

HISTORY: A 30-year-old male who developed acute, severe left-sided neck pain and headaches upon waking from sleep. Symptoms progressed that day to involve pain with swallowing and using his jaw. He presented to the emergency department three days later where an initial workup was completed including unknown labs and a CT of his neck. He was discharged with oxycodone and naproxen and a referral to a spine clinic where he was seen the following day. In clinic, he reported 7/10, sharp, constant, left-sided neck pain that was worse with any range of motion but not associated with any radiation to the arms. He did not have any previous history of neck trauma, infections, or new exposures. Denied fever, chills, skin changes PHYSICAL EXAMINATION: Examination in clinic revealed afebrile male in moderate acute distress. No visible cervical scoliosis or skin abnormalities. There was moderate tenderness over bilateral cervical paraspinal muscles, generalized tenderness over cervical spinous processes, and reduced range of motion with neck flexion, extension, and rotation secondary to pain. He was neurologically intact. Unable to fully assess Spurling test given significant pain with minimal range of motion. DIFFERENTIAL DIAGNOSIS: 1. Strain of cervical paraspinal muscles 2. Pre-vertebral abscess 3. Cervical disc herniation 4. Cervical calcific tendinitis TEST AND RESULTS:CT Soft Tissue Neck with Contrast: Pre-vertebral soft tissue edema / fluid. Small left sided calcifications just inferior to the C1 anterior arch suggestive of acute calcific tendinitis of the longus colli musculature. MRI Neck with and without Contrast: Pre-vertebral edema from C2 - C5 without organized fluid collection. Foci of low signal within the proximal most portion of the left longus colli muscle FINAL WORKING DIAGNOSIS: Calcific tendinitis of the left longus colli muscle TREATMENT AND OUTCOMES: He was prescribed Naproxen 500 mg twice daily for 5 days. He experienced near complete resolution of his pain on day 3 of NSAID administration.