 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

 College graduate  Works as a teacher  No vices

 conscious, coherent, in pain (6-7/10 on VAS) Vital Signs: BP= 120/70mmhgHR=96 bpm RR=20cpmT= 37 CBMI= 22 kg/m 2 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 spheres CN I: NA CN II: 2-3 mm EBRTL CN III, IV, VI: full EOMS CN V: (+) corneal reflex CN VII: (-) facial asymmetry CN VIII: gross hearing intact CN IX, X: (+) gag reflex CN XI: good shrug CN XII: tongue midline Motor: 5/5 on all Extremities Sensory: 100% light touch on all extremities Cerebellar: (-) dysdiadokinesia DTR’s: ++

Myofascial Pain Syndrome, cervical area r/o Cervical Radiculopathy Endometriosis 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?

PopulationAdult patients presenting with localized pain and tenderness of the neck InterventionX-ray vs MRI OutcomeSensitivity and specificity in diagnosing Cervical Radiculopathy MethodCross 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

PopulationAdult patients diagnosed with Myofascial Pain Syndrome InterventionEperisone + NSAID ComparisonBaclofen + NSAID OutcomeFaster relief of spasticity MethodRandomized control trial

 Thank you!