Some of the working diagnoses should include shoulder sprain/strain, cervical neuralgia from a compressed intervertebral foramen, cervical disc injury, myofasciitis of the lower cervical/upper thoracic region, Thoracic Outlet Syndrome causing compression of the neurovascular bundle.

Physical Exam Findings:

Cervical spine examination revealed spasms of the right anterior and medial scalenes, and right pectoralis, upper trapezius and SCM. Cervical ranges of motion were within normal limits with some “pulling” on the right cervical flexors and rotators. Anterior flexion fixations were noted for C 5,6,7 with tenderness to palpation of the attachment of the scalenes to the 1^st rib and SCM to the clavicle. Deep Tendon reflexes and upper extremity muscle strength testing were within normal limits.

Question: Based on the above findings, what other diagnostic evaluations would you perform for this patient’s condition?