Differential Diagnosis
- Single Most Likely Diagnosis
- Cervical Spondylosis with Radiculopathy: The patient's symptoms of neck pain, stiffness, and radiation to the left arm and middle finger are consistent with cervical spondylosis. The improvement with cervical distraction and myofascial release also supports this diagnosis. The patient's history of traumatic brain injury and chronic headaches may be contributing factors to her current condition.
- Other Likely Diagnoses
- Cervical Strain or Sprain: The patient's insidious onset of neck pain and stiffness could be due to a cervical strain or sprain, especially given her history of chiropractic care and acupuncture.
- Myofascial Pain Syndrome: The patient's symptoms of muscle stiffness and sensitivity in the neck and upper trapezius, as well as the improvement with myofascial release, suggest myofascial pain syndrome.
- Post-Traumatic Cervicalgia: The patient's history of traumatic brain injury and motor vehicle accident could be contributing to her current cervicalgia.
- Do Not Miss Diagnoses
- Cervical Spinal Stenosis: Although less likely, cervical spinal stenosis could be a possible diagnosis, especially given the patient's age and symptoms of neck pain and radiculopathy. Missing this diagnosis could lead to serious consequences, such as spinal cord injury or paralysis.
- Herniated Cervical Disc: A herniated cervical disc could also be a possible diagnosis, especially given the patient's symptoms of radiculopathy and neck pain. Missing this diagnosis could lead to serious consequences, such as nerve damage or paralysis.
- Multiple Sclerosis: Although rare, multiple sclerosis could be a possible diagnosis, especially given the patient's symptoms of numbness and tingling in the left arm and middle finger, as well as her positive Romberg's test. Missing this diagnosis could lead to delayed treatment and serious consequences.
- Rare Diagnoses
- Cervical Dystonia: Although rare, cervical dystonia could be a possible diagnosis, especially given the patient's symptoms of neck stiffness and muscle hypertonicity.
- Thoracic Outlet Syndrome: Although rare, thoracic outlet syndrome could be a possible diagnosis, especially given the patient's symptoms of radiculopathy and neck pain.
- Rheumatoid Arthritis: Although rare, rheumatoid arthritis could be a possible diagnosis, especially given the patient's symptoms of neck pain and stiffness, as well as her positive Romberg's test.