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PTupdate.com -> Disturbing case (March 12, 2008 10:35:10 PM)
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This past week I saw a physician, 40-something years old (won't say what type of MD, and please this is not the place to bring up issues as to why this lasted this long) at his request, for what he told me on the phone was UE weakness, and he wanted me to help with his home gym strengthening routine.
I had seen him 4 years ago for neck pain and shoulder weakness on the right. He had, from playing ball, strained his neck and had a lot of neck pain. 5 days later underwent kidney surgery. They radiographed the neck at the hospital, and all was clear. I saw him after the kidney recovery, finding limitation with RR, RSB, extension, and C4-5 weakness. We fixed the majority of these issues, and he went on his own. Saw him a year later for knee pain, and no neck issues.
So, he presents this past week describing severe UE weakness, now both sides, and difficulty even performing 5lb weighted biceps curls. Works out in his basement nightly "to fatigue". Symptoms began worsening 6 months ago, getting even crappier 3 months ago.
As he demonstrated things with his shirt on, I knew I was dealing with something bad. Had him take his shirt off, revealing severe supraspinatus, infraspinatus, and deltoid atrophy on both sides. Right shoulder so weak that active elevation was below 120, yet PROM easily to 160. Both shoulders fine for PROM, but 3/5 at best for all groups, and bi/tri not much better. Supination/pronation/wrist 4/5, fingers and hand normal..... no hand atrophy, no tremors, no dyskinetic movements. In fact, no neck, shoulder, or back pain.
While seated, muscle fasiculations in right infraspinatus and right triceps. Negative Hoffman, no LE issues, no visual, breathing, balance, coordination issues.
Reflexes close to normal, but if dealing with LMN, they actually would have been considered to be too reactive.
I told him he does not need to see me, but rather a neurologist, and fast. I personally am thinking brachial amyotrophic diplegia type problem, but would be interested to see what others are thinking before I get the neuro results. Please note I could have checked for a bunch of other things, but we got talking about music and Jerry Garcia....which is always more important. My other diagnosis possibilty is a severe central disc herniation or congenital stenosis, which may have compromised portions of the cord.
Obviously, I told him to stop exercising to "fatigue" for now
But, I had a stomach ache all day over this, my second (possibly) ALS-type syndrome pick-up in the past year. Being in the same age range, and a father myself, to me this just sucks really bad.
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