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- Sep 2, 2003
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34 yo with wasted left > right hand. Onset 4 years ago. Lots of pain and tingling. Nl. mentation, CN's, 5/5 and good bulk in delts, bis, tris, but 5-/5 in left wrist flex/ext, 4/5 in all hand intrinsics and thumb ext with marked atrophy on the left. On the right, presevation of bulk with 5-/5 hand intrinsics, all else 5/5. Sensation decreased in all nerve distributions of the hand, L>R. Has reduced reflexes on the left, and only 1+ on the right. Legs normal. MRI C-spine: small disc.
Sensories:
Left Median Anti Sensory
amp: 63.1 uV velocity: 46.7
Right Median Anti Sensory
33.0 46.9
Left Radial Anti Sensory
25.7 50.0
Right Radial Anti Sensory
36.1 52.2
Left Ulnar Anti Sensory
15.1 50.0
Right Ulnar Anti Sensory
40.5 48.1
Motor is normal, except for an ulnar amplitude of 2 mV with proportionate slowing.
EMG shows old chronic neurogenic changes in most muscles with huge, bizzare motor units. (Pronator, ExtDigCom, 1stDorInt, Triceps) No spontaneous activity. Delt/bi normal though. paraspinals normal.
So although 'normal,' the sensory side to side tell a story of an asymetric process distal to the root. The ulnar loss of amplitude is consistent with the exam. And the EMG shows
Another case of brachial plexopathy? Imaging is pending. I worry that the sensory stuff isn't 'real' enough and may warrant ALS. Perhaps I should have EMG'd the legs, suprascapular, but I can't do it all.
Sensories:
Left Median Anti Sensory
amp: 63.1 uV velocity: 46.7
Right Median Anti Sensory
33.0 46.9
Left Radial Anti Sensory
25.7 50.0
Right Radial Anti Sensory
36.1 52.2
Left Ulnar Anti Sensory
15.1 50.0
Right Ulnar Anti Sensory
40.5 48.1
Motor is normal, except for an ulnar amplitude of 2 mV with proportionate slowing.
EMG shows old chronic neurogenic changes in most muscles with huge, bizzare motor units. (Pronator, ExtDigCom, 1stDorInt, Triceps) No spontaneous activity. Delt/bi normal though. paraspinals normal.
So although 'normal,' the sensory side to side tell a story of an asymetric process distal to the root. The ulnar loss of amplitude is consistent with the exam. And the EMG shows
Another case of brachial plexopathy? Imaging is pending. I worry that the sensory stuff isn't 'real' enough and may warrant ALS. Perhaps I should have EMG'd the legs, suprascapular, but I can't do it all.