Author: Cassidy Foley, DO
Co Author #1: David H. Wang M.D. M.S.

Patient Presentation:
A previously healthy, 33-year old female presented with a one day history of difficulty breathing and sharp pain in her neck and anterior chest. The patient's symptoms began while performing a sirsasana headstand pose in a yoga class. She had performed many headstands in the past and she was able to hold this particular headstand pose even when she felt the onset of symptoms. After the pose, she described inhalation as more difficult for her than exhalation and inhalation was accompanied by sharp neck pain that radiated toward her anterior chest. The patient reported she could only breath shallowly. She admitted the respiratory symptoms, chest and neck pain were persistent for 24-hours before they improved. The patient did not go to the emergency department for a work-up of her complaint. She did not treat her pain at home. She found relief in breathing shallowly. Upon presentation to clinic, her respiratory symptoms had resolved and she had not performed any subsequent headstands. Case Photo #1

History:
The patient denied experiencing similar symptoms in the past. She denied any recent or past neck trauma. She admitted to recent insidious onset of aching in her arms and legs. The bilateral upper limb soreness was predominately at night and was significant enough for her to seek chiropractic treatment. However, the symptoms did not abate with chiropractic treatment. The patient did not take medications, smoke or have allergies. She had a family history of maternal multiple sclerosis.

Physical Exam:
Physical exam revealed an appropriate, athletic female, in no apparent distress. Blood pressure was 92/60, height was 68 inches, weight 132 pounds and her body mass index was 20.1. There were no rashes found on her skin. Examination of the upper extremities revealed 2/4 reflexes at the biceps, triceps and brachioradialis bilaterally. Her strength was 5/5 for finger abduction and grip strength. Her pulses were 2 plus bilaterally. The patient was not tender to palpation of the spinous processes or muscles of the cervical spine. She had full range of motion in flexion, extension, rotation and sidebending and motion did not recreate her symptoms. Her sensory exam was normal with negative Spurlings compression test bilaterally.

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