A 62 year old male with neck pain

A 62 year female who is the resident of Nalgonda presented to the OPD with the chief complaints of pain in the neck on the left side,left shoulder,left arm,left scapula upto elbow since 2 months 

HOPI:
Patient was apparently asymptomatic 2 months back then he developed pain in the neck region on the left side which is sudden in onset ,gradually progressive .
Pain is increased during the night time.
Swelling is seen over the scapula 6 years back and after 3 years back the swelling had brust and there was pus discharge from it.
At present he even have the swelling in the same region of the previous site.
He has a history of trauma due fall of  pot on the left shoulder which was filled with toddy 30years back.
Again he had a fracture in the left hand 10 years back.
He had no history of associated symptoms ,fever, nausea, vomiting, movement restrictions,numbness, parasethsia.

Past History:
He is a  known case of Diabetes mellitus type 2 for which he is taking Metformin 2 tablets/day takes after meals.
 History of hydrocele surgery on the left side 4years back
H/O  surgery for phimosis .

No history of hypertension,TB, Asthma, Leprosy, cardiovascular disease.

Personal History:
Appetite: Normal
Diet: mixed
Sleep : adequate
Bowel and bladder: normal
Addictions: Chronic alcoholic  1 bottle everyday since teenage. From 2 months he takes  quarter alcohol daily.

Family History:
Has the family history with his siblings.

General examination:
Patient is conscious coherent cooperative well oriented to time place person moderately built moderately nourished

Vitals
Temp afebrile
BP 110/70
PR 74 bpm
RR 16cpm

Pallor : Absent
Icterus: Absent
Cyanosis : Absent
Clubbing : Absent
Edema : Absent
Lymphadenopathy: absent

Systemic examination
CVS S1 S2 heard no murmurs
CNS  
RESP BAE NVBS
PER ABDOMEN Soft,non tender

Local examination:
On inspection :
Swelling near the scapula on left side
No scar

Palpation:
No pain from the cervical to thoracic vertebrae to the lateral side
Movement:
Pain on flexion , extension left lateral flexion,
Left rotation is restricted.





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