Review Question - QID 8241

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Cervical Radiculopathy QID: 8241 (SAE13BS.1)

QID 8241 (Type "8241" in App Search)

A 70-year-old man is experiencing neck pain, progressive weakness, and numbness in his arms and legs without bowel or bladder dysfunction or dysphagia. Upon examination, he has atrophy of his upper extremities but normal muscle bulk in his legs. Strength is diffusely 4/5 throughout. Cervical spine radiographs show spondylosis. Electromyography (EMG) reveals fibrillations with increased amplitude in the extensor carpi radialis and pronator teres. Nerve conduction studies demonstrate slowing conduction diffusely in the sural, peroneal, and ulnar nerves, and severe slowing in the median nerve. Testing of the tongue and thoracic paraspinal muscles does not show fibrillations or positive short waves. What is the most likely diagnosis?

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Amyotrophic lateral sclerosis

37%

400/1083

Cubital tunnel syndrome

3/1083

Normal aging

11%

114/1083

Cervical radiculopathy

50%

543/1083

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Physical examination and presentation is consistent with possible cervical radiculopathy vs motor neuron disease. EMG findings are most consistent with cervical radiculopathy. There is denervation (fasciculations and positive short waves) of the C6 innervated muscles consistent with radiculopathy. However, evaluation of other body regions does not show evidence of denervation (tongue, thoracic paraspinal muscles). Fasciculations in the hand muscles were not widespread. Nerve conduction suggests the presence of a peripheral polyneuropathy with possible superimposed median neuropathy. Amyotrophic lateral sclerosis is a motor neuron disease that affects both upper and lower neurons. Presentation includes rapid progression of weakness, muscle atrophy, fasciculations, spasticity, dysarthria, dysphagia, and respiratory compromise.