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A 60-year-old woman with osteoarthritis
Case 14
A 60-year-old woman with a history of osteoarthritis and chronic neck pain complains of sharp, stabbing
neck pain that radiates to her right shoulder. The radiating pain is particularly triggered with coughing or
sneezing. There is longstanding numbness in a patch of skin on the superior surface of the upper arm.
More recently, she has noticed mild clumsiness of her right hand, dragging of her right foot, and
increased urinary urgency. Forward flexion of her neck results in an electric-like volley of sensation down
her back.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies) would you like to obtain?
What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? How would you
monitor her condition and its treatment? What is the prognosis?
A 60-year-old woman with osteoarthritis
Case 14
A 60-year-old woman with a history of osteoarthritis and chronic neck pain complains of sharp, stabbing
neck pain that radiates to her right shoulder. The radiating pain is particularly triggered with coughing or
sneezing. There is longstanding numbness in a patch of skin on the superior surface of the upper arm.
More recently, she has noticed mild clumsiness of her right hand, dragging of her right foot, and
increased urinary urgency. Forward flexion of her neck results in an electric-like volley of sensation down
her back.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies) would you like to obtain?
What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? How would you
monitor her condition and its treatment? What is the prognosis?