AANEM Connect

We had a 40 years old male with no previous co-morbids in our edx lab for evaluation of non-specific generalized weakness since childhood which he noted has worsened recently with ho of neck pain. There was no radiation to arms, no reported sensory or motor weakness or bladder and bowel dysfunction.

OE: strength was good in all 4 limbs, relatively brisk reflexes (more in upper limb), hoffmans negative, plantars-down, no sensory level, was able to walk tandem, could walk few steps on toes and heels.

On NCS, right median sensory latencies and SNAP were normal, bilateral median motor were not-recordable bilaterally from APB. Ulnar motor and sensory were normal.

On needle examination few neurogenic units (polyphasic, broad) were found in right APB and bilateral ADM with no active denervation. Apart from these muscles, no EMG abnormalities found in bilateral upper limbs (including right EIP, PT, PQ, PL, FPL, biceps, triceps and left APB, FDI, FCU and EIP) and bilateral cervical paraspinals.

Since no significant abnormality was found in median SNAPs and EMG of median innervated muscles,

we did additional studies recording ulnar motor nerve from thenar (to rule out riche cannieu anastomosis) and median from hypothenar muscles (for MGA) which were inconclusive. Median nerve was then recorded from FPL which mostly showed ulnar motor wave form.

MRI cervical spine was reported multilevel disc degenerative disease most marked at C4-C5 level, resulting in mild compressive myelopathy (as reported )

Is this remote inactive cervical C8-T1 radiculopathy or proximal CB of bilateral median nerves but again EMG is normal in all median innervated muscles except minimally abnormal APB and, yes normal SNAPs?

Appreciate your input to understand this.

Thanks.