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  #1  
Old 09-16-2013
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Hammer and Otoscope Neck and Arm Neurology Question

A 45-year-old man has had a 1-week history of increasing neck pain when he turns his head to the right. He also has had a pins-and-needles sensation starting in the neck and radiating down the right arm into the thumb. His symptoms began 3 months ago when he developed severe pain in the neck and right shoulder. Neurologic examination shows limitation of motion on turning the neck to the right. There is 4+/5 weakness of the right biceps and decreased pinprick over the right thumb. Deep tendon reflexes are 1+ in the right biceps and brachioradialis; all others are 2+. Which of the following is the most likely diagnosis?

(A) Carpal tunnel syndrome
(B) Cervical root compression
(C) Multiple sclerosis
(D) Thoracic outlet syndrome
(E) Ulnar nerve compression
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Old 09-17-2013
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cervical root compression..
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Old 09-17-2013
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Quote:
Originally Posted by abcxyz View Post
A 45-year-old man has had a 1-week history of increasing neck pain when he turns his head to the right. He also has had a pins-and-needles sensation starting in the neck and radiating down the right arm into the thumb. His symptoms began 3 months ago when he developed severe pain in the neck and right shoulder. Neurologic examination shows limitation of motion on turning the neck to the right. There is 4+/5 weakness of the right biceps and decreased pinprick over the right thumb. Deep tendon reflexes are 1+ in the right biceps and brachioradialis; all others are 2+. Which of the following is the most likely diagnosis?

(A) Carpal tunnel syndrome
(B) Cervical root compression
(C) Multiple sclerosis
(D) Thoracic outlet syndrome
(E) Ulnar nerve compression

My answer is B.
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Old 09-17-2013
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Cervical root compression most likely
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Old 09-19-2013
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Yes, answer is Cervical root compression.

How do you differentiate between Cervical root compression and Thoracic outlet syndrome?
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Old 09-19-2013
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Thoracic outlet syndrome refers to compression of neuro-vascular structures supplying upper extremity. Pain in the neck and shoulder, numbness and tingling of the fingers, and a weak grip, signs of poor circulation in the hand or forearm (a bluish color, cold hands, or a swollen arm). Elevated arm stress test is used for screening of thoracic outlet syndrome.
I hope that help.
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