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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).

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