[Skip to Navigation]
Sign In
Views 1,019
Citations 0
JAMA Surgery Clinical Challenge
December 2018

A Visit to the Emergency Department With Neck and Shoulder Pain

Author Affiliations
  • 1Department of Surgery, Providence–Providence Park Hospital, Southfield, Michigan
JAMA Surg. 2018;153(12):1151-1152. doi:10.1001/jamasurg.2018.2729

A 56-year-old man presented to the emergency department with a 3-week history of worsening neck and shoulder pain. He had been seen in his primary care physician’s office about 2 weeks prior to emergency department presentation and had been treated for musculoskeletal symptoms. He had no history of recent trauma. He admitted to paresthesia and pain radiating down his right arm but denied any weakness. He had no difficulty with speech or swallowing. He had no medical comorbidities or prior surgery. On examination, he was noted to have some cervical midline spine tenderness. No weakness or sensory deficits were identified. No palpable lymphadenopathy, swelling, or mass was noted. A plain radiograph of the neck demonstrated tracheal deviation, and he then underwent computed tomography of the chest (Figure 1A) and magnetic resonance imaging of the cervical and thoracic spine (Figure 1B).

Add or change institution
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words