Persistent Neck Discomfort: Causes and Solutions for Swelling and Pain

Swelling in the front of the neck on both sides and centrally, near the clavicle, with discomfort, tenderness upon palpation, pain while swallowing, and a dry cough without sputum. Symptoms worsen from afternoon to evening?

On May 1, I experienced discomfort on the right side of my neck from the middle to near the clavicle, with pain upon pressure and difficulty swallowing.
By May 17, there was no improvement, and yawning also caused pain.
On May 18, a pediatric otolaryngologist examined me and noted no lumps or swelling, suggesting possible vascular inflammation.
I was prescribed PREDNISONE 10 mg tablets for 12 days, which completely alleviated my discomfort.
However, after stopping the medication, the pain returned, and in severe cases, swelling extended from behind my ear to the front of my neck, causing discomfort.
I also felt a sense of pressure in my head, which worsened in the afternoon and evening.

On June 3, my family doctor was unsure of the cause and recommended a neck ultrasound.
On June 6, swelling was noted on the right side, and mild pain began on the left lower side of my neck, along with difficulty swallowing.
On June 22, I underwent a neck ultrasound.
On June 23, I started experiencing a dry cough, especially when speaking, but without any phlegm.
The area of my neck that was painful upon pressure became very painful during coughing.
I also had thick saliva.

On June 24, I had a COVID-19 PCR test.
By June 25, the pain on the right side had decreased, but the left side and middle became very painful upon pressure, with swelling.
On June 27, my COVID-19 PCR test result was negative.
On June 28, my family doctor informed me that there were no abnormalities with my thyroid and advised me to continue monitoring myself.

On July 1, I noticed swelling and discomfort in the front of my neck on both sides and in the middle, extending to the area near the clavicle, with pain upon pressure and difficulty swallowing.
I also had a dry cough without phlegm, which worsened in the afternoon and evening.
Additionally, I experienced pain when touching the middle of my chest bone, and I am unsure which specialist to consult next.

Fi, 30~39 year old female. Ask Date: 2022/07/01

Dr. Liu Hongxiang reply Family Medicine

Dear Ms.
Fi,
Thank you for your detailed account of your current health status.
According to your letter, you have seen a physician three times, but your symptoms persist.
I would recommend that you consult an otolaryngologist again to assess your condition and determine if further examination or treatment is necessary.
Wishing you good health.
Sincerely,
Dr.
Liu Hongxiang

Reply Date: 2022/07/01

More Info

Persistent neck discomfort, especially when accompanied by symptoms such as swelling, pain, and difficulty swallowing, can be indicative of several underlying conditions. Based on the symptoms you've described, it seems that there may be a multifactorial issue at play, potentially involving inflammation, muscular strain, or even vascular concerns.

Possible Causes
1. Muscle Strain or Tension: Given the location of your discomfort, muscle strain is a common cause of neck pain. This can be exacerbated by poor posture, prolonged periods of sitting, or sleeping in an awkward position. Muscle tension can lead to localized pain and discomfort, especially when pressing on the affected area.

2. Inflammation: Your mention of a physician suggesting possible vascular inflammation is noteworthy. Conditions such as vasculitis can cause swelling and pain in the neck area. Inflammation can also occur in the lymph nodes, which can become reactive due to infections or other inflammatory processes.

3. Thyroid Issues: Although your recent ultrasound indicated no abnormalities in the thyroid, thyroiditis or other thyroid-related conditions can sometimes present with neck pain and swelling. It’s essential to keep this in mind, especially if symptoms persist.

4. Infections: Infections of the throat, such as pharyngitis or tonsillitis, can cause referred pain to the neck and lead to difficulty swallowing. Additionally, viral infections can cause generalized symptoms, including dry cough and discomfort in the neck.

5. Cervical Spine Issues: Conditions affecting the cervical spine, such as herniated discs or degenerative disc disease, can lead to neck pain that radiates to other areas, including the shoulders and arms. This could also explain the discomfort when yawning or swallowing.

6. Lymphadenopathy: Swollen lymph nodes in the neck can be a response to infection or other systemic conditions. If there is swelling present, it may be worth investigating further to rule out any underlying infections or malignancies.

Recommended Solutions
1. Medical Evaluation: Since your symptoms have persisted and evolved, it is crucial to follow up with a healthcare provider. A referral to a specialist, such as an otolaryngologist (ENT) or a neurologist, may be warranted to explore further diagnostic options.

2. Imaging Studies: While you have already undergone ultrasound, additional imaging such as MRI or CT scans may provide more detailed information about the structures in your neck and help identify any underlying issues.

3. Physical Therapy: Engaging in physical therapy can help address muscle tension and improve posture. A physical therapist can guide you through exercises designed to strengthen neck muscles and improve flexibility.

4. Medication: If inflammation is a significant factor, continuing anti-inflammatory medications as prescribed by your physician may help manage symptoms. Corticosteroids like prednisone can be effective in reducing inflammation but should be used under strict medical supervision.

5. Lifestyle Modifications: Incorporating ergonomic adjustments in your workspace, practicing good posture, and taking regular breaks from prolonged sitting can help alleviate muscle strain. Gentle neck stretches and exercises may also be beneficial.

6. Monitoring Symptoms: Keeping a detailed log of your symptoms, including when they worsen or improve, can provide valuable information to your healthcare provider and assist in diagnosing the underlying cause.

7. Hydration and Nutrition: Staying well-hydrated and maintaining a balanced diet can support overall health and may help reduce inflammation.

Conclusion
Persistent neck discomfort with associated symptoms can be complex and multifactorial. It is essential to work closely with healthcare professionals to identify the underlying cause and develop an appropriate treatment plan. Given the range of potential issues, a thorough evaluation and possibly further diagnostic testing will be key in managing your symptoms effectively. If symptoms worsen or new symptoms arise, seek immediate medical attention.

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