He describes intermittent, rather severe left arm pain of about
2 to 3 weeks’ duration. He had very similar pain in the right arm beginning about 2 months ago, but the right arm symptoms have now completely resolved. The pain is quite characteristic in that it is brought on by light weightlifting exercise, particularly when he raises weights above the head in a
military-press fashion. He can also develop some pain with pronation of the arm. The pain is felt along the inferolateral aspects of the humerus and is unassociated with weakness or complaints of numbness. There has been no report of change in bowel or bladder control and no leg symptoms whatsoever. He has had an MRI scan of the cervical spine, which was not particularly remarkable. At one point in time, it was noted that deep tendon reflexes were very difficult to elicit in both triceps. He reports no neck or shoulder pain whatsoever. He has been on Feldene q.d. for about 3 weeks, and this has been of some benefit to him. His only medication otherwise is Synthroid.
2 to 3 weeks’ duration. He had very similar pain in the right arm beginning about 2 months ago, but the right arm symptoms have now completely resolved. The pain is quite characteristic in that it is brought on by light weightlifting exercise, particularly when he raises weights above the head in a
military-press fashion. He can also develop some pain with pronation of the arm. The pain is felt along the inferolateral aspects of the humerus and is unassociated with weakness or complaints of numbness. There has been no report of change in bowel or bladder control and no leg symptoms whatsoever. He has had an MRI scan of the cervical spine, which was not particularly remarkable. At one point in time, it was noted that deep tendon reflexes were very difficult to elicit in both triceps. He reports no neck or shoulder pain whatsoever. He has been on Feldene q.d. for about 3 weeks, and this has been of some benefit to him. His only medication otherwise is Synthroid.
His past medical history is entirely unremarkable.
On neurologic exam, the patient is alert and oriented, in no severe distress. Higher cortical and cranial nerve exams are unremarkable. Motor exam reveals 5/5 strength. There is no focal muscle atrophy, no muscle fasciculations. He does have some loss of muscle bulk in the shoulder girdle and proximal upper arms bilaterally, but this is not particularly prominent. Sensation is intact to all modalities. Deep tendon reflexes are 1+ at the triceps bilaterally, 2+ at the biceps, and 3+ at the brachioradialis, and 2 to 3+ at the knees and ankles. Toes are downgoing.
EMG (ELECTROMYOGRAM)/NERVE CONDUCTION VELOCITY STUDIES
See worksheets for details. EMG study was performed on the following muscles of the left upper extremity: first dorsal interosseous, pronator teres, brachioradialis, extensor digitorum communis, biceps, triceps, deltoid. Mid and lower cervical paraspinous muscles were studied on both the right and left. The EMG portion of the exam was entirely within normal limits. The nerve conduction portion of this study was likewise essentially within normal limits.
IMPRESSION
This is a normal left upper extremity EMG/NCV (electromyographic/nerve conduction velocity) study. I suspect that this left arm pain and prior right arm pain are primarily musculoskeletal in etiology, although it is quite curious that the distribution of pain does seem to follow the course of the radial nerve in the humerus. In this regard, no abnormalities were found on either clinical or EMG (electromyogram) examination in the distribution of the radial nerve.
FOOTNOTE
Line 8 (Page 1). Alternative: 2-3.
Line 35 (Page 1). Alternative: 2+ to 3+.
Line 38 (Page 1). The dictated abbreviation EMG was translated in the heading for clarity.
Lines 49 (Page 1)-6 (Page 2). The abbreviations and short forms were expanded in the Impression for clarity.
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