The patient is a 59-year-old female who presents with neck and arm pain.
The patient is pleasant and appropriate to situation, articulate, and a good historian. Gait is brisk with good coordination. She has hyperesthesia of the bilateral arms; left greater than right, maximally at the index and middle fingers. Motor strength testing shows mild weakness of the left deltoid, biceps and triceps. Reflexes are 1+ at the triceps, biceps and brachioradialis bilaterally and symmetrically. Spurling’s test is positive with reproduction of pain over the left shoulder and radial side of the arm. Hoffman’s test is negative bilaterally and there is no clonus. Visual Analog Scale (VAS) is 8.
Arm pain was relieved for 4 weeks with interlaminar epidural steroid injections. Physical therapy and activity modification produced minimal improvement.
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