Our Patient
Our patient was a 46 year-old male complaining of pain in his left shoulder and neck. During the clinical exam, it was revealed that two days prior, he had received an allergy injection in his left arm for asthma.
Initial Diagnosis
The initial diagnosis identified myofascial trigger points in the left rotator cuff and neck muscles. Diagnostic ultrasound imaging further revealed a 15mm multilocular lesion in the left suboccipital area (the posterior neck muscles below the occipital bone). The lesion included enlarged lymph nodes with entrapment of the occipital nerve, with trigger points near the site of irritation.
Further Diagnostic Recommendations
To better understand the full picture, further diagnostic steps were recommended:
- A fine needle aspiration biopsy of the lymph nodes was done to help determine the nature of the lesion.
- Further imaging studies with CT scan or MRI.
- Blood tests to provide more information about the patient’s overall health.
Proposed Treatment Plan
The following treatment plan was proposed:
- Use of anti-inflammatory drugs to reduce pain and inflammation.
- Ultrasound-guided dry needling to eliminate trigger points.
- Physical therapy to address muscle imbalances, improve range of motion, and strengthen the affected muscles.
- Further evaluation of affected lymph nodes.
- Ongoing allergy management.
- Ongoing pain management using occipital nerve blocks or other pain management strategies.
- Followup and monitoring of patient progress.
Our Conclusion
This case emphasizes the potential association between lymph node lesions and myofascial trigger points as the underlying cause of neck and shoulder pain, and the importance of a personalized treatment plan vs generic neck pain treatment.
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