45 F neck pain and fever since 10 days


 A 45 y/o female, weaver/handloom worker, resident of bongir came with chief complaints of 

- neck pain since 10 days and 

- fever since 10 days. 


HOPI

patient was apparently asymptomatic 10 days ago and then she developed 

- neck pain in the left side which was insidious in onset, radiating to the upper limb and associated with neck stiffness. aggravated on flexion and extension of the neck and apparently temporarily relieved on using oil.  

- no h/o trauma 

- she developed low grade fever which was relieved on medication, associated with fatigue, myalgia and headache. not associated with chills and rigors.

- no h/o shortness of breath, no h/o cough, no h/o cold, no h/o sore throat, no h/o abdominal pain, no h/o vomitings.

- h/o  tingling of bilateral upper limbs.


Past illness 

• k/c/o hypertension since 4 years and is on medication (losartan 50 mg tablets) 

• n/k/c/o tb, asthma, epilepsy, hypo or hyperthyroidism. 

• no surgical history and no h/o blood transfusions 


Family history 

• her mother is a k/c/o hypertension 


Personal history 

• appetite is normal 

• bowel and bladder movements are regular 

• sleep is disturbed since 4 years 

• no addictions, no known allergies 


She has been a weaver since 10 years old and has been doing it for most part of her life but she stopped since 10 days because of the neck pain. 

daily routine - 

she wakes up at 6 in the morning and does household chores. 

eats breakfast at 10 am and then starts working (weaving) until lunch which is at around 3pm

she eats rice and curry or pickle for almost all her meals. after lunch, she continues weaving until dinner time which is at 9 pm and then goes to bed at 10 pm but has disturbed sleep.

Her daily routine has been different since she started experiencing neck pain and stiffness. Her ability to weave has been hindered because of it.


General examination

Patient was conscious, coherent and co-operative, 

clubbing of fingers is not seen 

Pedal edema is slightly present

No Icterus, Cyanosis, Generalised lymphadenopathy,

Vitals

Temperature – 98.6 F 

Pulse rate – 88 bpm 

Respiratory rate – 16 cpm

BP – 160/100 mm Hg 

SPO2 – 98% on room air  

GRBS – 256 mg/dl


Systemic examination

 cvs - 

no thrills, 

no cardiac murmurs, 

S1 and S2 sounds heard

 rs -

 dyspnoea is absent, 

position of trachea is central,

 no wheeze, 

vesicular breath sounds present  

abdomen - 

obese in shape, 

no tenderness, 

no palpable mass, 

hernial orifices are normal,

 no bruits or free fluid,

 liver and spleen are not palpable, 

bowel sounds are present. 

cns -

conscious 

speech is normal

kerning's sign is negative 

brudzinskis sign negative

rombergs sign negative

cranial nerves, motor system, sensory system are all intact and normal.

reflexes -

                        RT.            LT

biceps      2p.                2p


triceps        2p                2p


supinator     1+              1+


knee          2p.               2p


ankle          1+                 1+ 


Neck examination :

restriction of movements is seen

pain increases on flexion and extension 

neck stiffness is present 

kernig’s sign - negative

brudzinski - negative


cerebellar signs -

no finger nose incoordination

no heel knee incoordination

gait is normal 


Investigations- 



















provisional diagnosis - 

? cervical radiculopathy 


treatment - 

inj diclofenac - im  sos

inj tramadol - 2 ampules in 100 ml normal saline, iv, tid

tab dolo 650 mg -  oral  sos

tab nicardia 10 mg - oral  sos


23/08/23 














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