MEDizzy - You are caring for a 16-year-old gymnast who is complaining

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Acute Complaints

You are caring for a 16-year-old gymnast who is complaining of neck pain. Although she is very active, she denies significant trauma precipitating the pain. She has tried nonsteroidal anti-inflammatory agents, ice, rest, and physical therapy with no results. She denies radiculopathy, fever, chills, weight loss, or other significant symptoms. Her medical and social histories are unremarkable, other than the fact that she reports trying marijuana once at a friend’s house. In addition to the fact that she isn’t getting better with treatment, which item described in her history represents a “red flag” for a serious underlying condition or disease?

ExplanationThere are several findings that are clues to serious underlying conditions or diseases that warrant further workup for neck pain. They include: • The presence of radiculopathy: if the patient has sensory or motor changes, spasticity or bladder/bowel changes, further workup is indicated. • The concern for infection: patients with fever or chills, an immunocompromising condition, or alcohol/drug abuse, further workup is indicated. • The concern for a fracture: patients with significant trauma or a history of osteoporosis should be further evaluated. • The concern for a tumor: patients with a history of unexplained weight loss, a history of cancer, or age less than 20 or more than 49 should be further evaluated.