case presentation (evidence-based medicine)

This is a case of M.T, 37 year-old female, married, Christian, right-handed, from Malate, Manila who came in due to stiffening and pain in the neck.

Patient is a non-diabetic, non-hypertensive.

Few months PTC – on and off nape pain, described as piercing, radiating to shoulder area with pin-prick sensation. 4/10 on VAS. Resolves spontaneously. No history of trauma. No meds taken. No consult done.

1 day PTC – after bout of prolonged coughing, noted the same nape pain (piercing in character), which radiates to the rest of the head and shoulder (pin-prick in character), 6/10 on VAS, associated with slight stiffening of the neck, (+) some degree of limitation of range of motion of the neck due to pain.

At day of consult – persistence of stiffening and pain of neck area prompted consult.

• (-) fever/weight loss/easy fatigability/ no loss of appetite• (-) dizziness• (-) cough/colds/difficulty of breathing• (-) chest pain/palpitations• (-) abdominal pain/diarrhea/change in bowel movement/melena,/hematochezia/hematemesis• (-) dysuria/polyuria/ polydipsia/polyphagia• (-) loss of consciousness/seizures

(+) Endometriosis with adenomyosis –maintained on DMPA

(-) HPN, (-) DM, (-) PTB, (-) BA (-) previous hospitalization (-) previous operation (-) allergy to food and drugs

DM

HPN

37 38

4

7

College graduate Works as a teacher No vices

conscious, coherent, in pain (6-7/10 on VAS)Vital Signs: BP= 120/70mmhg HR=96 bpmRR=20cpm T= 37 C BMI= 22 kg/m2

HEENT: anicteric sclerae, pink palpebral conjunctivae, (-) cervicolympadenopathy, (-) tonsillopharyngeal congestion

CHEST: equal chest expansion, no retraction, clear breath sounds, (-) crackles

CVS: adynamic precordium, distinct heart sounds, normal rate regular rhythm, no murmur

ABDOMEN: flat, normoactive bowel sounds, nontender

EXTREMITIES: full and equal pulses, no cyanosis, no edema

(+) direct tenderness on neck and shoulder area (+) limitation of flexion, extension, rotation of

the neck on passive and active motion

Neuro Exam: GCS 15, oriented to 3 spheresCN I: NACN II: 2-3 mm EBRTLCN III, IV, VI: full EOMSCN V: (+) corneal reflexCN VII: (-) facial asymmetryCN VIII: gross hearing intactCN IX, X: (+) gag reflexCN XI: good shrugCN XII: tongue midline

Motor: 5/5 on all ExtremitiesSensory: 100% light touch on all extremitiesCerebellar: (-) dysdiadokinesiaDTR’s: ++

Myofascial Pain Syndrome, cervical arear/o Cervical RadiculopathyEndometriosis with Adenomyosis

Dx: Cervical AP-L Tx: 1. Eperisone HCl 50mg/tab 1 tab TID 2. Mefenamic Acid 500mg q8 PRN for pain Warm Compress on cervical area Avoid sudden movement of neck

In adult patients presenting with localized pain and stiffness of the neck, what is the sensitivity and specificity of x-ray vs MRI in diagnosing Cervical Radiculopathy, using a cross sectional study?

Population Adult patients presenting with localized pain and tenderness of the neck

Intervention X-ray vs MRI

Outcome Sensitivity and specificity in diagnosing Cervical Radiculopathy

Method Cross sectional study

In adult patients diagnosed with Myofascial Pain Syndrome, is Eperisone + NSAID more effective than Baclofen + NSAID in achieving faster relief of spasticity, using randomized control trial

Population Adult patients diagnosed with Myofascial Pain Syndrome

Intervention Eperisone + NSAID

Comparison Baclofen + NSAID

Outcome Faster relief of spasticity

Method Randomized control trial

Thank you!