Neck pain in patients with undifferentiated connective tissue dysplasia: Diagnostic challenges
https://doi.org/10.21518/ms2026-295
Abstract
This article discusses the differential diagnosis of treatment-resistant neck pain. Traditionally, cervicalgia is considered a nonspecific musculoskeletal pain successfully treated with standard treatment (NSAIDs, muscle relaxants) for 2–4 weeks. However, in the two presented clinical cases of middle-aged patients (45 and 48 years old) with subacute, intense pain lasting 1–2 months, standard therapy proved ineffective, necessitating a revision of the diagnostic framework. This description is of interest because it demonstrates a rare cause of secondary cervicalgia–vertebrobasilar dolichoectasia–simulating nonspecific musculoskeletal pain. Key “red flags” for further investigation included: reluctance to treatment, persistent pain, dissociation between pain severity and local muscle tension, and phenotypic features of connective tissue dysplasia (positive Beighton criteria). MR angiography verified compression of the medulla oblongata and pons by a tortuous, dolichoectatic left vertebral artery. As a result, the diagnosis was revised from nonspecific to secondary pain due to neurovascular conflict, and the patient was referred to a neurosurgeon. Therefore, in cases of prolonged neck pain associated with connective tissue dysplasia that is refractory to standard therapy, vascular anomalies must be excluded to promptly adjust the management strategy for this patient population.
Keywords
neck pain,
cervicalgia,
vertebral artery,
dolichoectasia,
connective tissue dysplasia,
joint hypermobility syndrome
Supporting agencies: The authors would like to express their gratitude to all participants of the Cystic Fibrosis Patient Registry of the Russian Federation (CFPR-RF). The study was conducted in association with the All-Russian Patient Union as part of the Observational Assessment Program on the Current Cystic Fibrosis Treatment Landscape in Real-Life Clinical Practice within the project Institute of Accredited Public Cystic Fibrosis Expert
About the Authors
D. Kh. Khaibullina
Kazan State Medical Academy – a branch of the Russian Medical Academy of Continuing Professional Education
Russian Federation
Russian Federation
Dina Kh. Khaibullina, Cand. Sci. (Med.), Associate Professor of the Department of Neurology
36, Butlerov St., Kazan, 420012
Y. N. Maksimov
Kazan State Medical Academy – a branch of the Russian Medical Academy of Continuing Professional Education
Russian Federation
Russian Federation
Yuri N. Maksimov, Cand. Sci. (Med.), Associate Professor of the Department of Neurology
36, Butlerov St., Kazan, 420012
K. R. Bilalova
BARSMED LLC
Russian Federation
Russian Federation
Kamilla R. Bilalova, Radiologist
2, Khusain Mavlyutov St., Kazan, 420101
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Khaibullina DK, Maksimov YN, Bilalova KR. Neck pain in patients with undifferentiated connective tissue dysplasia: Diagnostic challenges. Meditsinskiy sovet = Medical Council. (In Russ.) https://doi.org/10.21518/ms2026-295
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