Peer Reviewed

What's The Take Home?

A 67-Year-Old Woman With Neck And Shoulder Pain

Ronald N. Rubin, MD1,2 —Series Editor


    1Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
    2Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania


    Rubin RN. A 67-year-old woman with neck and shoulder pain. Consultant. 2023;63(4):e11. doi:10.25270/con.2023.03.000007


    The author reports no relevant financial relationships.


    Ronald N. Rubin, MD, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA 19140 (

    Introduction. A 67-year-old woman presented with neck and shoulder discomfort for nearly a month.

    Patient history. The patient felt pain in her neck and shoulders with subacute onset about once a week. She called her primary physician and was prescribed rest, heat, and over the counter analgesics, but showed no improvement. There was no history of trauma. An in-person visit revealed some direct tenderness in the top of her shoulders, but her neurological exam was negative.

    Diagnostic testing. Consultations to neurology and orthopedics specialists were ordered. These consultations resulted in evaluations for migraine and cervical spinal root compression, but workups including cervical spine films and MRI of the brain and spinal cord were unremarkable. A battery of blood studies revealed a very mild normocytic anemia (12.5 gms/dL), normal chemistries, biochemical profiles, and a sedimentation of 38 mm/hr. Conservative therapy was continued, but there was no improvement after 3 more weeks. In fact, she felt worse with more severe discomfort of the neck and shoulders, most severe in the morning but not interfering with sleep. Beyond the discomfort, there was now significant stiffness and “weakness” of the affected areas especially when lifting her arms. The patient felt upset by the lack of progress toward a specific diagnosis. Another battery of blood studies was sent as was further radiologic evaluation. Meanwhile, an empiric therapeutic intervention was initiated pending results.


    (Answer and discussion on the next page)


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