?CERVICAL SPONDYLOSIS WITH ALLERGIC RHINITIS WITH ANXIETY NEUROSIS

A 45 year patient came to me with complaints of left middle shoulder pain and u can say left cervical pain on and off since 5-6 years,,,and according to history he has given he also feels pain in left chest since same duration. He feels giddiness sometimes and extreme weakness. During history taking he told me that he consistently sneezes (doctor mujhe hamesha sneezing hoti hai aur past mai mujhe eosinophilia ki shikayat thi),,even in past also he used to get cough and cold ,,,,but at present he does not have dry or productive cough,,only sneezing is there,,,,he took many antihistamines and steroid nasal spray and drop without any relief. In this case his main concern is left upper shoulder pain and cervical pain may be radiating to left chest,,,,he consulted many orthopaedic doctors who diagnosed it as case of cervical spondylosis and treated it with NSAIDS and muscle relaxants and patches but he got no relief,,,,,he still has pain in left upper shoulder and neck region. I performed a examination but it not frozen shoulder,,,,no pain on adduction,,abduction,,,circumduction,,,,no local tenderness,,,,no history of trauma. Patient is a tailor. He also underwent many physiotherapy session for many weeks to months. He has done all the blood investigation like CBC,,,LFT,,,KFT,,CRP,,,RA,,,URIC ACID,,,S CALCIUM,,,FBS//PPBS,,HBA1C,,THYROID TEST,,ECG all are normal. He has done X-ray cervical spine and lumbar spine ,,,im posting it just go through it,,,,,so respected doctors please give ur expert opinion on this trivial case,,,I will be very much thankful to u all.

(Edited)

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Middle aged pt and tailor by profession His present complaints are corelating with his posture of tailoring likely cervical radiculopathy due to postural compression or facitis on lt side Since pain is referred to shoulder and anterior chest are just manifestations of cervical pains only still my advice would to r/o cardiac pain by ecg and 2decho My question in history which i find missing is has pt ever taken ATT as xray chest report is suggestive of infective lesions bilateral in chest ifthat is yes than his symptoms would need to see as auto toxicity of ATT which do cause refractory vertigo and need to evaluate History of frequent sneezing with h/o cough in past is obviously indicate Allergic rhinitis or atrophic rhinitis Could be dust 9f linnen while tailoring could be a reason Beside tab Levocetrizine5mg+tab monteleukast 10mg 1od I will suggest try inj histaglobe 1vial /sc weekly for 2months and tapper off gradually Beside metanasal spray to be use So far treatment is concerned Pt need to use cervical collar constantly at least while working Daily neck shoulder exercises as routine Physiotherapy Some yogic postures and yogic kriya for allergic rhinitis We need to keep on medication off and on Tab eterocoxib+thiocholchisone 8mg 1bd Cap indomethacin 25mg 1tds Tab betahistamine 16mg 1od at bedtime Multivitamins supplements Counseling Followup

Thanx dr Pushkar ji Bhomia
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? LOSS OF CERVICAL ..LORDOSIS..WITH .. MUSCULAR SPASMS .. AND .. REDUCED .. INTERVERTEBRAL SPACES.. WITH .. INFECTIVE ETIOLOGY IN .. CXR..STUDY .. NEED'S .. CLINICOPATHOLOGICAL EVALUATION WITH EXPERTS OPINION TO CONCLUDE DIAGNOSIS AND MANAGEMENT ..

Thank you doctor
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Valuable opinion
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Occupation. Posture. Muscular spasm. Lower zone lung opacities. ? CCF. Or infective. CT chest and correlate clinically

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Loss of cervical lordosis I V B spaces reduced Muscles spasm Advised MRI

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Evaluate for active infection. Adv Sputum examination sos HRCT thorax

I agree
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Need evaluation CT chest MRI cervical spine

Thank you doctor
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Adv MRI Cervical and L/S Spine Also Evaluate active infection Till then Adv tab pregabalin 0D Bt And tab A to z od Hot Fomentation locally

Thank you doctor
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RESPECTED SIR.............THANK YOU FOR YOUR PATIENT ELABORATED MEDICINAL HISTORY ALONG WITH TESTS AND TREATMENTS. IN MY OPINION HE REQUIRES SOME PSYCHOLOGICAL COUNSELLING WITH REST.HE MIGHT BE SUFFERS SOME FINANCIAL / FAMILY RELATED STRESS / TENSIONS.SO HE MAY REQUIRED PSYCHOLOGIST AND A PSYCHIATRIST.AFTER HE LEARN SOME LIFE STYLE MODIFICATIONS ALONG WITH ERGONOMICALLY REQUIRES SOME CHANGES / MODIFICATIONS.AFTER YOU WILL EXPLAIN ABOUT HIS CONDITION.................BECAUSE HE ALMOST DONE MAXIMUM MEDICAL ACCURATE / CORRECT TREATMENT. THANK YOU SIR.......................!

MRI cervical spine

I agree
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