Disclosures: Samantha Mastanduno, DO: Nothing to disclose

Case Description: A 57-year-old male who had been doing weight-lifting, “reverse” pull-ups, and strenuous neck motions presented after competing in a pull-up contest. After 20 pull-ups, he experienced a sudden electrical shock-like pain in his left upper scapular region with radiation to his left arm followed by whole arm burning. With pain gradually improved, he noticed weakness of left hand grip with numbness of ulnar side of forearm/hand. Without remarkable neck pain, he was given a clinical diagnosis of left brachial plexus injury and referred for electrodiagnostic test.

Setting: Clinic

Patient: 57-year-old male

Assessment/Results: Normal ulnar and medial antebrachial sensory nerve conduction were against lower trunk/medial cord injury. Electromyography (EMG) was indicative of left C8/T1 radiculopathy with evidence of partial denervation/reinnervation in abductor pollicis brevis, flexor carpi ulnaris, first dorsal interosseous, and C8/T1 paraspinal muscles. With negative EMG of finger extensors, T1 radiculopathy was suggested. Magnetic resonance imaging (MRI) showed left posterolateral disc herniation into T1-2 neuroforamina with compression of the exiting left T1 nerve root. Patient was educated on appropriate neck exercises and positioning. Three months post-injury patient reports improved left grip strength with resolution of pain and numbness.

Discussion: Isolated T1 radiculopathy is rarely reported as it is clinically and electrophysiologically difficult to separate from C8 radiculopathy. In our case, combined EMG result of positive C8/T1 muscles and negative C7/8 muscles with left T1 root compression on MRI confirmed T1 radiculopathy. The mechanism of injury in this patient is unclear, however, combined local muscles’ fast contractions with prolonged neck hyperextension may have caused the T1/2 disc herniation.

Conclusion: T1 radiculopathy and disc herniation at T1-2 are not commonly reported and it may happen during strenuous pull-ups with improper cervical posture. With the overabundance of new exercise fads, many involving timed competitions, it is important to counsel patients on proper form to help prevent acute disc herniations.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-acute-t1-radiculopathy-as-result-of-a-pull-up-contest-a-case-report/