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- Oct 2, 2007
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81 yo female, fell 2.5 months ago, Fx C1 without paralysis, in a halo, Fx left distal radius, treated with casting. post-casting pt c/o burning pain in hand, indicates middle fingers more than the rest, but all involved, up to mid-forearm. referred for EMG.
Strength and reflexes normal throughout BUEs, sensation reduced throughout the whole left hand. Hoffman's negative.
NCV shows left median motor with amplitude around 3 (nl >5) with normal distal onset, reduced NCV in the forearm around 46, normal in the upper arm 54.
Left ulnar motor shows normal onset, normal amplitude, slow NCV in the forearm around 48, normal across the elbow 56.
Right median motor normal distal onset and amplitude, slow NCV forearm 48.
F-waves normal bilateral median, slightly delayed left ulnar.
Left median sensory absent, left ulnar and right median sensories show normal onset, amplitude and NCV.
Needle of the left arm shows CRD's in the biceps and pronator teres - ssustained at about 100Hz or so, not diffuse throughout the muscles - more patchy. Otherwise needle exam benign including deltoid, triceps, FDIM and APB.
I could not do parapspinals due to the halo. I didn't do more due to Medicare restrictions.
My thought is of a polyneuropathy, mild, axonal type with a possible left C6 (vs 7?) radic. But the needle is not conclusive enough. Could a partial central-cord syndrome do this? Any thoughts appreciated.
Strength and reflexes normal throughout BUEs, sensation reduced throughout the whole left hand. Hoffman's negative.
NCV shows left median motor with amplitude around 3 (nl >5) with normal distal onset, reduced NCV in the forearm around 46, normal in the upper arm 54.
Left ulnar motor shows normal onset, normal amplitude, slow NCV in the forearm around 48, normal across the elbow 56.
Right median motor normal distal onset and amplitude, slow NCV forearm 48.
F-waves normal bilateral median, slightly delayed left ulnar.
Left median sensory absent, left ulnar and right median sensories show normal onset, amplitude and NCV.
Needle of the left arm shows CRD's in the biceps and pronator teres - ssustained at about 100Hz or so, not diffuse throughout the muscles - more patchy. Otherwise needle exam benign including deltoid, triceps, FDIM and APB.
I could not do parapspinals due to the halo. I didn't do more due to Medicare restrictions.
My thought is of a polyneuropathy, mild, axonal type with a possible left C6 (vs 7?) radic. But the needle is not conclusive enough. Could a partial central-cord syndrome do this? Any thoughts appreciated.