wry neck

On the last day of my musculo prac when i felt like i was getting the hang of musculo, I had one new pt that i had not planned for. She called up complaining of extreme neck pain after a bad night sleep and needed to see a physio. She was driven in and 15 minutes later she had arrived. She presented with a posture of nearly full range (L) side flexion, 1/2 (L) range rotation and 1/2 range flexion all to open up her right side. This was a classic acute wry neck presentation that was just as extreme as wat we learnt about it.

When it came to Ax, she was so irritable the only thing that could be done was put on a heat pack and hopefully reduce some of the discomfort and muscle tone. Following this she was very tender on her (R) side and had strong muscle guarding and pain responses resisting a neutral position. On PPIVM Ax there was a clear limitation at C2/3, and she was diagnosed with acute wry neck at (R) C2/3.
Her other Rx consisted of gentle upslope technique for (R) rot'n at C2/3 and a SNAG at C2 (L) for (R) rot'n. She also received postural advice and positioning, as well as AROM rot'n for a HEP.

I found this case fascinating and a great way to finish off my prac as it was a new and confronting experience where i had not seen an acute Cx pt prior to this. She presented in such a textbook way, which i always thought after learning about it was exaggerated. She was also incredibly irratable which we also leant about, making it very difficult to Ax and Rx. I think the message i got from this patient is that everything we learn at uni does exist and the content is from real life experience. I think when i actually work as a physio ill keep all my notes close-by for the next time i see a new presentation that again is likely to fit the profile detailed in out guides and lecture notes.