845 - Oboe-Playing Related Cervicalgia Relieved by Radiofrequency Ablation in a Professional Oboist: A Case Report

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

AN

Andrea Nikolis, MD

Resident Physician
University of Colorado Department of Physical Medicine and Rehabilitation
Burr Ridge, Illinois, United States

Co-Author(s)

LB

Lindsay Burke, MD

Resident Physician
University of Colorado Department of Physical Medicine and Rehabilitation
Aurora, Colorado, United States
AM

Adele Meron, MD

Attending Physician
University of Colorado Department of Physical Medicine and Rehabilitation
Aurora, Colorado, United States

Case Diagnosis: This case highlights a patient with multifactorial cervical pain, though the circumstantial nature of his pain while playing oboe is suggestive of a stress-related or inflammatory response such as mechanical sensitization.

Case Description:
A 32 year old male professional oboist presented with severe axial neck pain for two years, which only occurred while playing the oboe. Magnetic resonance imaging (MRI) of the cervical spine revealed mild facet arthrosis at C2-C3 levels which was discordant with the patient’s pain severity. After failing conservative treatment, he underwent successful diagnostic bilateral medial branch blocks (MBB) at the third occipital nerve and C3 medial branch, targeting the C2-C3 facet joint, and subsequent radiofrequency ablation (RFA) of the same level with good pain relief. He was able to return to playing the oboe with mild residual pain. He noted progressively worsening symptoms in the following months for which he then underwent successful MBB of the C3-C4 facet joint level followed by RFA. After RFA of both the C2-C3 and C3-C4 facet joint levels, the patient had complete pain relief and returned to playing the oboe professionally.

Discussions: Neck pain is common in musicians due to mechanical stress from prolonged, repetitive neck flexion and poor postural alignment. Specifically, musicians who play woodwind instruments must control oropharyngeal airflow and increase their upper airway pressure to produce sound, creating mechanical stress. Over time, these biomechanics create mechanical sensitization of surrounding structures due to neurogenic inflammation, in addition to degenerative changes from increased axial loads.

Conclusions: The biomechanics of playing an instrument such as the oboe create excessive cervical force from suboptimal posture and increased oropharyngeal pressure, which ultimately increase the risk of developing mechanical sensitization. The associated neurogenic inflammation in such cases contribute to circumstantial neck pain, which presents differently than more consistent symptoms related to degenerative cervical spine pathology.