Disclosures: Marine Dididze, MD, PhD: Nothing to disclose

Case Description: Patient presented to outpatient rehabilitation clinic complaining of chronic left shoulder and recent onset of left anterior chest pain. Patient had been treated by sports orthopedic surgeon for the chronic left shoulder pain after a rotator cuff repair in 2016. About 6 months ago he developed a ‘different” pain in his left shoulder and in the left anterior chest. He denied trauma although reported left shoulder cracking sensation while lifting weights prior to pain onset. He received NSAIDs, physical therapy and intra-articular corticosteroid injection without improvement. Left anterior chest pain gradually worsened, he placed his left arm in a sling. Left shoulder MR arthrogram ruled out acute intra-articular pathology, MR of the chest was negative for pectoralis muscle injury and MR angiogram excluded thoracic outlet syndrome. He rated pain between 8-10/10, aggravated with left arm movements and alleviated with rest. He denied numbness or tingling in the left arm but occasionally reported radiation of pain from the neck to shoulder and chest. He took cyclobenzaprine and methylprednisone with minimal improvement.

Setting: Outpatient Rehabilitation Department of Academic Medical Center.

Patient: A 38-year-old male.

Assessment/Results: Focused physical examination of the neck, bilateral shoulders and upper extremities revealed: full motor strength throughout, sensation diminished to light touch in the left cervical (C) 5 dermatome distribution; full active and passive range of motion in the neck and shoulders; positive tenderness to palpation on the anterior chest over the pectoralis muscle, negative special tests. Electromyography/nerve conduction studies revealed sub-acute to chronic C5 radiculopathy. Possible left ganglion cyst seen on MRI of the chest. Patient underwent left C5 selective nerve root block that provided decrease in pain to 0/10.

Discussion: This is a unique case of the atypical presentation of C5 radiculopathy.

Conclusion: In case of anterior chest pain, C5 radiculopathy should be included in a differential diagnosis.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/unusual-presentation-of-cervical-radiculopathy-a-case-report/