Case Study 1:
Patient with Neck Pain

Jim, a 59–year-old Asian man presented to a chiropractic clinic in HKSAR with a 1–month history of aching and numbness of his posterior neck and bilateral shoulders. He had an active 6–month history of tuberculosis, which caused an occasional productive cough, and was under medical treatment with a spectrum of antibiotics during this time (ie, isoniazid, rifampin, pyrazinamide, and ethambutol), as supervised by a specialty chest hospital with monthly follow-up visits and serial chest radiographs every 1–2 months.

The patient’s tuberculosis was first suspected 6 months prior after he developed a cough and underwent chest radiography. This was followed up by a Mantoux test, which was strongly positive. His previous providers also initially scheduled a flexible fiberoptic bronchoscopy, but later canceled it as his sputum culture was positive for Mycobacterium tuberculosis, and chest computed tomography (CT) findings were compatible with tuberculosis. At this point he began pharmacologic treatment for tuberculosis with directly observed therapy, which continued through presentation to the chiropractic office.

He described that the neck pain began secondary to episodes of coughing and had negatively impacted his sleep quality. The patient reported an 8 out of 10 pain severity on the numeric rating scale. He had a 50–pack-year history of smoking, was a social drinker, and worked as an interior decorator. The patient had a medical history of hereditary elliptocytosis, and at age 33 had a spontaneous pneumothorax. He denied having a history of cancer. His family history was significant for lung cancer (mother) and hereditary elliptocytosis (father). The patient endorsed occasional hoarseness but denied any bowel or bladder symptoms.

Previous treatment for his neck pain directed by his primary care provider included prescription pain medications (nonsteroidal anti-inflammatory drugs and acetaminophen) and rehabilitation exercises provided by a physical therapist. The patient also had received acupuncture for his neck pain. As no previous treatments provided the patient relief, he sought out chiropractic care (Figure 1).

The patient’s most recent chest radiograph report from 1 month prior reported patchy airspace opacities with a nodular appearance in the right upper lung zone, suggestive of pneumonia. Review of a report of his high-resolution computed tomography (CT) of the thorax from 6 months prior noted right apical fibrocalcific changes, mild bronchiectasis, tiny nodules up to 2 millimeters in both lungs, and shotty non-enlarged mediastinal and hilar lymph nodes. There was no mention of a suspicious lung mass or tumor in these reports.