Chiari Malformation Type I, presenting as scapulothoracic pain: a case report

Patients presenting with recalcitrant symptoms, which are resistant to a range of physical interventions over an extended period of time, need to be examined with care. A 'forensic' approach to the assessment of these patients, with a sensitive approach to the results of the test procedures is required to ensure the practitioner does not miss the more obscure causes. This case report presents a patient who was referred for a clinical assessment for long standing scapular pain, which had been labelled myofascial pain. Through a thorough approach to examination a number of flags appeared which suggested a need for further investigation. These investigations identified that the patient demonstrated a Chiari Malformation Type 1. On review 5 months following neurosurgical intervention her symptoms were significantly reduced. Chiari Malformations Type 1 are often diagnosed in adulthood when symptoms usually first appear. These symptoms may mimic those found with musculoskeletal conditions. Whilst we lack specific clinical tests for this condition, a thorough assessment should identify sufficient 'flags' for referral for further investigations.