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.

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.

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