The patient reported significant chronic neck pain with radicular symptoms that have increased over the last few months. Further evaluation revealed diffuse weakness in her upper extremities, significant scapulothoracic dyskinesia with decreased range of motion and impingement of both shoulders, and reduction in lateral rotation of the cervical spine. She also had cervical facet discomfort, or inflammation and pain in the neck area. Reflexes were globally diminished. The patient was referred for an MRI and lateral X-ray to confirm the diagnosis.

Fluoroscopically guided C4–7 interlaminar steroid injection was successful in alleviating many of her symptoms. Recommend to begin combined physical therapy (PT) and occupational therapy (OT) to assist in alleviating symptoms.