objective: To describe and discuss evaluation and management of a patient with upper quarter myofascial pain syndrome involving the cervical spine and shoulder girdle. clinical features: A 51-year-old female had pain in the left ear, head, cervical spine and left upper extremity for two years. The symptoms had not responded favorably to previous care. The following findings were present: decreased cervical range of motion, forward heat posture with rounded shoulders and a reproduction of the patient's complaints upon palpation of trigger points in the upper quarter region. The patient was diagnosed with cervical myofascial pain syndrome (ICD-9 code 729.1) complicated by segmental and postural dysfunction. intervention and outcome: Manual therapy techniques were utilized in the initial stage of treatment, including high velocity-low amplitude diversified chiropractic technique to C7-T1 and T3-T4 once a week for four weeks. A home stretching program was prescribed in the initial phase of treatment. The patient demonstrated objective improvement but still experienced residual ear pain and headaches, leading to referral for trigger point injections for the upper trapezius and sternocleidomastoid muscle. The patient reported additional improvement after injection. The patient was progressed to an active rehabilitation program consisting of cervical isometric maneuvers and progressive resistance exercise. The patient's activities of daily living significantly improved as demonstrated by outcome assessment tools such as the Vernon-Mior neck disability index and numerical pain scales. Maximal clinical improvement was achieved. A telephone consultation one-year following discharge revealed no residual complaints. conclusion: Management of a patient with upper quarter myofascial pain syndrome by soft tissue techniques, rehabilitation and injections is discussed. Based upon the care previously provided to the patient, the treatment program provided in this case report, including the proper timing of initiating a rehabilitation program, seemed essential in restoring function.
