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February 10, 1989

Nine-ball Neck

JAMA. 1989;261(6):866. doi:10.1001/jama.1989.03420060070036

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To the Editor.—  Billiards may not look like a sport that could induce injury, but one case illustrates its danger.

Report of a Case.—  A 56-year-old man complained of tightness of the right cervical muscles and soreness of the right shoulder that occasionally interfered with sleep, was associated with brief morning stiffness, and was noted to be worse a day or two after playing pocket billiards, especially nine-ball. Muscular tenderness of the nuchal and trapezius muscles on the right side with trigger points at the base of the skull, the midtrapezius muscle, and anteromedial to the shoulder was present, as well as skinfold tenderness. Forced abduction produced a sensation of "pulling" in the shoulder.Treatment was successful with conditioning exercises, proper instruction in technique, massage of tender muscles, application of local heat, and more frequent participation in billiards. Therapy with muscle relaxants, anti-inflammatory drugs, and analgesics was not required.