Asymmetric Brachioradialis Deficiency

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Asymmetric Brachioradialis Deficiency - Page #1

Author: Alexander Senk, MD Co Author #1: Brionn Tonkin, MD Physical Medicine and Rehabilitation Hennepin County Medical Center Minneapolis, MN Patient Presentation: A 28-year-old right hand dominant male presented with complaints of painless weakness and asymmetry of his left proximal forearm in comparison with his right. He first noticed these issues about 8 months ago when performing curls. The patient is unable to identify a precipitating event or recall a traumatic injury. He denies accompanying sensory impairment. History: His past medical history is remarkable for a living donor kidney transplant for membranoproliferative glomerulonephritis and subsequent ongoing immunosuppressant therapy. Physical Exam: GEN: Well-nourished Asian male in no acute distress. PSYCH: Pleasant, cooperative and insightful with warm affect and congruent mood. RESP: Unlabored at rest, speaks with ease, no audible wheezes. CVS: Distal pulses intact with warm, well perfused extremities without edema. MSK: Frank focal atrophy of left brachioradialis with 0/5 strength. Case Photo #1 4/5 strength with left elbow flexion, supination, wrist extension and finger extension. Otherwise, 5/5 strength throughout bilateral upper and lower extremities. NEURO: Oriented in all spheres. Left triceps tendon with 2+ DTR. 3+ DTR and normal tone throughout remainder of bilateral upper and lower extremities. Clonus is present with bilateral forced dorsiflexion. Bilateral Hoffman�s sign are present with equivocal bilateral Babinski�s and negative bilateral Oppenheim�s. Normal sensation to light, sharp, and proprioception. Steady gait. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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