Differential Diagnosis

The patient's symptoms of immediate rise in pain levels and soreness in the site of injury, 'pins and needles' sensation, tingling, and numbness feeling after receiving chiropractic treatment can be attributed to several possible diagnoses. Here's a categorized list of potential diagnoses:

• Single most likely diagnosis

  • Muscle strain or sprain: The immediate increase in pain and soreness after chiropractic treatment could be due to over-manipulation or excessive force applied during the treatment, leading to muscle strain or sprain. The 'pins and needles' sensation and tingling could be related to temporary nerve irritation.

• Other Likely diagnoses

  • Nerve root irritation: The chiropractic treatment might have irritated a nerve root, causing the patient to experience pain, tingling, and numbness in the shoulder blades.
  • Joint mobilization reaction: Some patients may experience a temporary reaction to joint mobilization, which can include increased pain, stiffness, and neurological symptoms like tingling and numbness.
  • Radiculopathy: The symptoms could be indicative of radiculopathy, which is damage or irritation to a nerve root, causing pain, numbness, and tingling in the affected area.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

  • Vertebral artery dissection (VAD) or stroke: Although rare, chiropractic neck manipulation has been associated with an increased risk of VAD and stroke. It is essential to consider this possibility, especially if the patient experiences severe headache, dizziness, or sudden weakness.
  • Spinal cord injury: A severe injury to the spinal cord could occur due to excessive force or improper technique during chiropractic treatment, leading to serious and potentially permanent neurological damage.

• Rare diagnoses

  • Cauda equina syndrome: This is a rare condition where the nerves in the lower spine are compressed, causing pain, numbness, and tingling in the legs and potentially affecting bladder and bowel function.
  • Disc herniation: The chiropractic treatment might have caused a disc herniation, which could lead to nerve compression and the patient's symptoms. However, this would be less likely without a history of significant trauma or pre-existing disc disease.