Examination should include cervical spine static and motion palpation, cervical spine ranges of motion (passive and active), compression testing of the cervical spine, deep tendon reflexes of the biceps and triceps, dermatome evaluation of the upper extremity, palpation of the muscles and myofascia of the upper extremity.

Physical Exam Findings: Cervical spine fixations and myospasms of the suboccipital region are consistent with her prior visits with overall 50% improvement. Ranges of motion have increased without pain 50% since her initial visit. Compression testing of the cervical spine is negative. Deep tendon reflexes of her biceps and triceps reflexes are within normal limits. Dermatome evaluation of the skin over her biceps and dorsum of her hand demonstrated mild hypoesthesia, however this numbness was not continuous throughout a specific dermatome but local to these two regions.

Palpation of the muscle of the myofascia of the upper extremity determined that she has myofascial soft tissue contractures and spasms of the subscapularis muscle at the anterior axillary region near the humerus which is a new finding compared to her initial exam.  

Question: What is your working diagnosis at this point?