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In yesterday’s "Weekly Medical Questions" column, we pushed the latest issue of NEJM Knowledge+ Question of the Week.
The first 3 fingers on the radial side of the patient's right hand are tingling and numb.
What is the most likely diagnosis? Today, we announce the answer.
Do you see the answer? Of course, answering right is not the goal, but mastering the essentials and expanding knowledge is the kingly way.
Answer: C6 cervical radiculopathy learning points: The patient showed hand numbness, biceps weakness, and loss of biceps reflex, and the Tinel sign was negative.
The most likely diagnosis is C6 cervical radiculopathy.
Knowledge expansion The most likely diagnosis of this patient is C6 radiculopathy.
Symptoms include weakness in elbow flexion, numbness on the radial side of the hand, sometimes accompanied by numbness on one side of the arm, weakened or disappeared biceps reflex, and occasionally weakened or disappeared brachioradialis reflex.
C8 radiculopathy can cause weakened grip and numbness of the ulnar hand and forearm.
This patient showed weakness in the proximal muscles of the hand, and carpal tunnel syndrome can be ruled out.
The positive likelihood ratio of Tinel sign examination for carpal tunnel syndrome is 1.
4, and the negative likelihood ratio is 0.
8; this shows that whether it is positive or negative, Tinel sign is of little value in the diagnosis of carpal tunnel syndrome.
Patients with spinal cord injury will have signs of spinal cord disease, such as Babinski’s sign, muscle spasms, or increased pathological reflexes.
Thoracic radiculopathy does not affect the hands.
【Weekly Medical Questions】will continue to be updated.
What do you want to see or learn? Please tell us through the comments and look forward to your precious comments and suggestions.
References 1.
Doughty CT and Bowley MP.
Entrapment neuropathies of the upper extremity.
Med Clin North Am 2019 Mar; 103:357.
2.
Corey DL and Comeau D.
Cervical radiculopathy.
Med Clin North Am 2014 Jul; 98:791.
3.
D'Arcy CA and McGee S.
The rational clinical examination.
Does this patient have carpal tunnel syndrome? JAMA 2000 Jun 21; 283:3110.
Copyright information Translation, writing or commissioning of the "NEJM Frontiers in Medicine" jointly created by the Journal of Medicine (NEJM).
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities.
The patient is an elderly male with a history of smoking.
He has frequent or long-term heartburn after treatment with proton pump inhibitors and should be evaluated for Barrett's esophagus and esophageal adenocarcinoma.
The first 3 fingers on the radial side of the patient's right hand are tingling and numb.
What is the most likely diagnosis? Today, we announce the answer.
Do you see the answer? Of course, answering right is not the goal, but mastering the essentials and expanding knowledge is the kingly way.
Answer: C6 cervical radiculopathy learning points: The patient showed hand numbness, biceps weakness, and loss of biceps reflex, and the Tinel sign was negative.
The most likely diagnosis is C6 cervical radiculopathy.
Knowledge expansion The most likely diagnosis of this patient is C6 radiculopathy.
Symptoms include weakness in elbow flexion, numbness on the radial side of the hand, sometimes accompanied by numbness on one side of the arm, weakened or disappeared biceps reflex, and occasionally weakened or disappeared brachioradialis reflex.
C8 radiculopathy can cause weakened grip and numbness of the ulnar hand and forearm.
This patient showed weakness in the proximal muscles of the hand, and carpal tunnel syndrome can be ruled out.
The positive likelihood ratio of Tinel sign examination for carpal tunnel syndrome is 1.
4, and the negative likelihood ratio is 0.
8; this shows that whether it is positive or negative, Tinel sign is of little value in the diagnosis of carpal tunnel syndrome.
Patients with spinal cord injury will have signs of spinal cord disease, such as Babinski’s sign, muscle spasms, or increased pathological reflexes.
Thoracic radiculopathy does not affect the hands.
【Weekly Medical Questions】will continue to be updated.
What do you want to see or learn? Please tell us through the comments and look forward to your precious comments and suggestions.
References 1.
Doughty CT and Bowley MP.
Entrapment neuropathies of the upper extremity.
Med Clin North Am 2019 Mar; 103:357.
2.
Corey DL and Comeau D.
Cervical radiculopathy.
Med Clin North Am 2014 Jul; 98:791.
3.
D'Arcy CA and McGee S.
The rational clinical examination.
Does this patient have carpal tunnel syndrome? JAMA 2000 Jun 21; 283:3110.
Copyright information Translation, writing or commissioning of the "NEJM Frontiers in Medicine" jointly created by the Journal of Medicine (NEJM).
The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn.
Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities.
The patient is an elderly male with a history of smoking.
He has frequent or long-term heartburn after treatment with proton pump inhibitors and should be evaluated for Barrett's esophagus and esophageal adenocarcinoma.
