Dancing to Decompression: A Case Study

Case Diagnosis: 33 yo dancer presents with acute onset neck and shoulder pain associated with abduction weakness, found to have severe C5-6 cervical stenosis and left-sided foraminal stenosis at C4-5, with confirmation of muscle atrophy on diagnostic ultrasound, leading to surgical decompression.

Case Description or Program Description: 33 yo LHD professional dancer presented with acute onset left neck and shoulder pain. Patient was initially evaluated in urgent care for pain and weakness to the left arm after stretching. Exam was notable for 3/5 strength on abduction, flexion, and supination, with positive Spurlings and hyporeflexia to C5.

Setting: Outpatient Sports Clinic

Assessment/Results: Initial shoulder radiographs were negative. Given suspicion for C5 radiculopathy, MRI was ordered which showed severe central stenosis at C5-6 and left-sided foraminal stenosis at C4-5. Patient deferred surgical intervention at the time, thus treatment with medrol dose pack and PT was attempted. This minimally improved symptoms and patient was lost to follow-up for several months. He returned with worsening weakness to deltoid and wrist extensors. Diagnostic ultrasound performed revealed marked atrophy of the left deltoid, which prompted referral to orthopedic surgery. Given limitations impacting his ability to dance, the patient underwent C4-5, C5-6 ACDF with cord and bilateral nerve root decompression with recovery of strength.

Discussion (relevance): Diagnostic ultrasound proves to be a useful tool, especially as an adjunct to MRI or EMG to assess for muscle bulk, asymmetry and fatty atrophy, which, can indicate evidence of nerve damage.

Conclusions: Cervical spondylosis is a degenerative process that can result in cord and nerve root compression. When the C5 level and nerve root is involved, the deltoid specifically loses major innervation and atrophies, as seen in this patient. While the atrophy itself was not easily identified on gross physical exam in this well-muscled individual, it was revealed on diagnostic ultrasound, which provided concrete visual data to prompt more aggressive treatment.