Case Study: Chronic Right-Sided Neck Pain after Dry Needling

Our Patient

Our patient is a female in her 20s who came to us with severe right-sided neck pain, consequent to a dry needling session at another clinic. Her pain spanned from the upper trapezius area and down the medial scapular border. The patient has a history of chronic right-sided neck pain and previously had a cervical discectomy – a procedure where the disc is removed and the bones fused together – but the surgery provided no relief.

The Challenge

The patient had been to multiple therapists, chiropractors and medical doctors whose treatments made her symptoms worse. Diagnostic imaging modalities revealed nothing abnormal, and no one was able to help her. She was told by one doctor that she had shoulder labral tears, but nothing was done to address the condition. She came to NYDNRehab in hopes that we could find a solution for her chronic pain.

Our Diagnostic Process

Clinical Exam

During the clinical exam, we assessed the patient to have:

• Kyphoscoliotic posture
• Forward head carriage
• Scissoring rib cage
• Paradoxical breathing
• Severe anterior pelvic tilt
• Bilateral scapular instability.

The patient’s scapular instability was a mixed type, with right scapular dyskinesis and bilateral protracted scapular position. She exhibited hypermobility, with a negative Beighton score for EDS syndrome. Both shoulder joints tested positive for instability. However both of her shoulder joints tested positive to instability testing.

Results of a neurological exam were normal, and palpation of the cervical spine did not elicit pain. However, palpation of the left upper trapezius elicited pain and tenderness. We also found multiple fascial densifications along the retro-lateral line.

Diagnostic Ultrasonography

When visualized with ultrasound imaging, both rotator cuffs appeared normal, but dynamic testing found the right posterior labrum to be hypermobile. We found an enlarged singular lymph node adjacent to the spinal accessory nerve in the fascial plane between the sternocleidomastoid muscle and the upper trapezius. Pressure on the enlarged lymph node reproduced her symptoms.

Discussion

When asked if she had been sick during her dry needling procedure, the patient replied that she had been diagnosed with a COVID infection the following day. We deduced that the dry needling procedure had induced further inflammation of the lymph node, which was already swollen due to Covid. This in turn irritated the spinal accessory nerve, causing referred pain that precisely replicated the patient’s symptoms.

Dry needling is a procedure intended to target myofascial trigger points. However, without the advantage of ultrasound imaging, dry needling performed “blind” can do more harm than good, with the needles penetrating nerves, blood vessels and other structures. Ultrasound not only confirms the presence of trigger points, but it is an invaluable tool for guiding needling procedures, to precisely hit the targeted tissues without harming other structures.