SHM Converge Scientific Abstract ePoster Gallery-A Pain in the Neck: Cervical Radiculopathy Presenting as Persistent Arm Pain in a Young Sickle Cell Patient

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A 33-year-old woman with sickle cell disease presented with acute right chest, arm, and leg pain initially thought to be a vaso-occlusive crisis. However, her labs were not strongly supportive of hemolysis or crisis, and despite multimodal pain treatment she developed persistent severe right upper extremity pain, numbness, tingling, and mild weakness. A more focused neurologic exam revealed a positive Hoffmann sign in the right hand, raising concern for an upper motor neuron process and prompting MRI of the cervical spine.<br /><br />Imaging showed cervical disc disease, including C4-5 central disc protrusion with moderate right neuroforaminal stenosis and a C6-7 disc protrusion causing spinal cord compression. These findings explained her symptoms in the C4-7 dermatomal distribution and led to the diagnosis of cervical radiculopathy rather than sickle cell vaso-occlusive pain.<br /><br />She was started on pregabalin, which improved her pain and allowed discontinuation of IV opioids. She was discharged with neurosurgery and physical therapy follow-up.<br /><br />The case emphasizes that clinicians should keep a broad differential diagnosis in sickle cell patients with acute or neuropathic pain. Chronic neuropathic pain is common in adults with SCD and can create anchoring bias toward assuming all pain is vaso-occlusive. Sickle cell disease can also accelerate spinal degeneration and other vertebral pathology, making cervical disease possible even in younger patients. A careful neurologic exam, especially looking for signs such as Hoffmann’s reflex, can be critical in identifying central or upper motor neuron causes of pain.

Asset Subtitle

Erin Finn

Meta Tag

Author List Erin Finn, James Rogers, John R. Stephens

Category Clinical Vignettes

Concept Sickle Cell Disease

Concept Nerve Root Disorder

Concept Acute Neuropathic Pain

Concept Pain Crisis

Concept Neurologic Physical Examination

Distinguished Non-Finalist

Presenter Organization University of North Carolina

Presenting Author Erin Finn

Track Adult

Keywords

sickle cell disease

cervical radiculopathy

neuropathic pain

Hoffmann sign

spinal cord compression

cervical disc protrusion

upper motor neuron

dermatomal distribution

neurosurgery follow-up

pregabalin

Sickle Cell Disease

Nerve Root Disorder

Acute Neuropathic Pain

Pain Crisis

Neurologic Physical Examination