Cervical spine injury leaves COPD patient with tough decision

History

Rachel, is a 67-year-old pensioner who lives alone with her pup Toby. She has COPD and rheumatoid arthritis.

She presents with a four-month history of arm pain, following an incident on Christmas Day, when she reports that she went for a walk with Toby and had a fall, hitting her head.

She was take to emergency immediately after the fall, where a CT brain and cervical spine revealed a cavernous malformation causing proptosis.

Examination was reported as otherwise normal.

She was discharged from the ED the same day with a referral to the ophthalmology outpatient department.

Rachel reports that she saw her GP two weeks later, describing ongoing pain and markedly reduced movement of her left arm.

She was referred for a shoulder ultrasound, which was normal.

She was subsequently seen several times by a physiotherapist, reviewed by