A 49-year-old right hand dominant electrician presented with complaints of progressive weakness in his right arm. He also described having pain in his neck extending down the front of his arm to his hand. He was having difficulty lifting objects with his right hand and performing repetitive-type motions, with weakness of his right shoulder and biceps. He reported occasional numbness in his thumb and index finger while at work.
He did not recall any trauma to his neck or arm. He denied bowel or bladder dysfunction, and was not experiencing disturbances in his gait. On further questioning he denied any history of smoking, diabetes, or hypertension. He also denied night pain.
Examination revealed a patient in no acute distress, with a full range of motion of the cervical spine. Reproduction of his right arm pain was elicited with extension of the neck and rotation of his head to the right (Spurling's maneuver). He appeared to have mild deltoid wasting on his right with prominence of his acromion. Motor testing was symmetric with 5/5 strength in bilateral deltoids, biceps, triceps, wrist flexors, wrist extensors, finger flexors, finger extensors, and hand intrinsics. His deep tendon reflexes were 2+ and symmetric, with the exception of the biceps reflex, which was depressed on the right side compared with the left. He had a negative Hoffman's sign and his gait was within normal limits. Tinel's and Phalen's testing of the median nerve at the wrist were not provocative.
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