Disclosures: Tom Lin, MD: No financial relationships or conflicts of interest

Case Diagnosis: Cervical spondylotic amyotrophy

Case Description or Program Description: A 36-year-old otherwise healthy right-handed man presented with chief complaint of left elbow muscle twitching and left arm and hand weakness. He had no pain at rest, but had painful burning sensation in the elbow with use. He was treated for ‘tennis elbow’ for 1 year with no improvement and had recently lost his welding job due to inability to use the left hand. On exam, there was severe and obvious atrophy of the left triceps, forearm, and intrinsic hand muscles. Strength was 3/5 in elbow extension, 4/5 in wrist extension and flexion, finger extension and flexion and hand intrinsics. Sensation was normal. There were visible muscle fasciculations in the left elbow extensor mass.

Setting: Outpatient PM&R office

Assessment/Results: Electrodiagnostic evaluation showed severe acute and chronic denervation primarily affecting C7 and C8 innervated muscles and paraspinals, with a normal sensory examination. Cervical spine x-ray showed degenerative disc disease from C4 to C7. Cervical MRI showed a congenitally narrow canal with severe multilevel foraminal stenosis due to disc osteophyte complexes worst at the left C7 foramen, without evidence of cord compression. He was diagnosed with cervical spondylotic amyotrophy. He was assessed by spine surgery and decision was made to closely observe clinically with plan to decompress with any progression of weakness or spinal cord changes.

Discussion (relevance): Differential diagnosis of painless unilateral limb atrophy includes neuralgic amyotrophy, monomelic amyotrophy, amyotrophic lateral sclerosis, and many other rare neurological conditions. Cervical spondylotic amyotrophy is defined by upper limb muscle atrophy without sensory changes secondary to spondylosis. Focal compression of the anterior nerve root at the neuroforaminal entrance causes painless compressive cervical radiculopathy with primarily motor symptoms.

Conclusions: Cervical spondylotic amyotrophy should be considered in the differential diagnosis of unilateral limb atrophy but due to its painless nature can present with a prolonged time to diagnosis.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-twitching-elbow-a-welder-with-unilateral-upper-limb-atrophy-a-case-report/