Quick Case Study

Resolving a Misdiagnosed Loss of Arm Strength

Man with pain in arm. Pain in the human body on a gray background

A physically fit, 38-year-old active-duty US Navy corpsman presented with progressive weakness in his arms. An examination revealed no deficits. Cervical radiculopathy was the initial diagnosis. A primary care physician recommended conservative treatment.

To reduce inflammation, the patient was prescribed corticosteroids and pain medication. While undergoing physical therapy, he was encouraged to avoid unusually demanding activity involving his arms.

However, his condition persisted. His arms continued to weaken, and he reported significant decline in the strength and function in his dominant arm. The patient was referred to Melissa M. Erickson, MD, an orthopaedic and spine surgeon at Duke.

Question: What diagnosis and treatment were recommended by Erickson to resolve the patient’s continuing arm weakness?

View case conclusion  

Answer: After Erickson examined the patient and obtained magnetic resonance imaging, she diagnosed him with spinal nerve root compression. Erickson performed anterior cervical discectomy and fusion.

“The patient was continuing to lose strength in his arms when I saw him,” she says. “As a well-conditioned soldier who was also a bow hunter, the worsening weakness was limiting his professional activity as well as his hobbies.”

The patient reported the weakness as being most evident in his biceps, Erickson recalls. Following a 1-day hospital stay for anterior cervical discectomy and fusion, the patient’s inflammation receded and his strength began to return. Within a few weeks, the patient resumed a full schedule of military activity.

“This patient was a cut above in terms of physical condition and regular activity,” she says. “He sensed the loss of strength more keenly than many patients.”

The patient recovered and has repeatedly thanked the team for his experience and outcome at Duke. “He was enthusiastically ecstatic about everyone involved in his treatment,” she says.

The condition is not unusual, Erickson says, but identifying the problem and offering a prompt solution is key. “This was a bread-and-butter surgical case in some respects,” Erickson says. “For referring regional physicians, this is a good example of Duke identifying and executing a successful treatment quickly for a patient who was in progressive decline.”