All right, welcome. My name is Divine. This is episode 565 of the Divine Intervention Podcasts.

Today we're going to be continuing the 3137 series. It's going to be part 11B.

All right. Let's jump to 105 because we stopped at 104 last time.

So we have this 44-year-old female who's coming to the office.

She says her neck and shoulder pain have come back again.

So the HPI,

she has a five-year history of myofascial pain syndrome, a 12-month history of right-sided neck and

shoulder pain with no trauma, risked the neck and shoulder pain a six out of 10. Dillistration

of the neck and right shoulder and aproxin therapy has not helped. Six months ago, she received

a local anesthetic trigger

point injection in the right trapezius muscle with complete resolution of pain for four months.

48 hours after she injected, she developed severe aging and redness, symptoms resolved

spontaneously. She was informed that she's allergic to local anesthetics but was not told which

one was used.

That's not very wise.

Okay, so she has a history of depression.

Hypothyroidism is on an SSRI thyroid replacement therapy and a proxen.

Has allergies to local anesthetics.

Her mom has a history of fibromyalgia.

Doesn't smoke cigarettes or drink alcoholic beverages.

If you look at a vital signs, they're actually completely fine. Nothing wrong there. And then physical exam, pretty okay. But MSK

exam, palpation of the right upper trapezius muscle triggers, discloses a trigger point within

...