A 64-year-old male presents to the clinic with complaints of gradual onset of weakness to the left hand. He is left hand dominant. He has had ongoing numbness and tingling that feels as though it starts at his elbow. However, over the past 2-3 days he had been dropping items due to the weakness. He denies any recent injuries but state that he sustained a crushing injury to the left thumb 4 years ago. He is employed as a mechanic. Several years ago, he tripped over a tire and fell backwards striking his head on the fender of a car. He didn’t seek medical attention because he only had a small scrape on his elbow. A CT of the head is within normal limits and all labs are normal with the exception of a slightly elevated, non-fasting blood sugar (135). He has no history of diabetes. An x-ray of the neck reveals mild-to-moderate degenerative disc disease at C6-C7 with neuroforaminal narrowing and slight impingement of the exiting nerve root.
In your Case Study Analysis related to the scenario provided, explain the following:
Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
Any racial/ethnic variables that may impact physiological functioning.
How these processes interact to affect the patient.
Full Answer Section
The most likely cause of the compression neuropathy is the patient's degenerative disc disease at C6-C7. The degenerative disc disease has caused narrowing of the neural foramen, which is the opening in the spine through which the nerve root passes. The narrowing of the neural foramen has caused compression of the C6 nerve root, which is resulting in the patient's symptoms.
Another possible cause of the compression neuropathy is the patient's history of a head injury. The head injury may have caused damage to the C6 nerve root, which could be contributing to the patient's symptoms.
Musculoskeletal Pathophysiology
The patient's weakness in the left hand is also consistent with a compression neuropathy of the left C6 nerve root. The C6 nerve root provides motor innervation to the muscles that extend the wrist and fingers. The compression of the nerve root is preventing the nerve from transmitting signals to the muscles, which is resulting in weakness.
The patient's occupation as a mechanic may also be a contributing factor to his symptoms. The repetitive use of his hands and arms in his job may have put stress on the C6 nerve root, which could have contributed to the development of the compression neuropathy.
Racial/Ethnic Variables
There are no known racial/ethnic variables that would impact the physiological functioning of the patient in this case. The patient's symptoms are consistent with a compression neuropathy of the left C6 nerve root, regardless of his race or ethnicity.
How the Processes Interact to Affect the Patient
The compression of the left C6 nerve root is causing the patient's symptoms of numbness, tingling, and weakness in the left hand. The compression of the nerve root is preventing the nerve from transmitting signals to the muscles, which is resulting in the weakness. The numbness and tingling are caused by the compression of the nerve root, which is interfering with the nerve's ability to transmit signals to the sensory receptors in the hand.
The patient's occupation as a mechanic may also be a contributing factor to his symptoms. The repetitive use of his hands and arms in his job may have put stress on the C6 nerve root, which could have contributed to the development of the compression neuropathy.
The patient's symptoms are likely to worsen over time if the compression of the nerve root is not relieved. The numbness and tingling may become more severe, and the weakness may progress. If the compression of the nerve root is not relieved, the patient may eventually lose all sensation and motor function in the left hand.
The patient should be referred to a neurologist for further evaluation and treatment. The neurologist may order additional tests, such as an MRI of the neck, to confirm the diagnosis of a compression neuropathy of the left C6 nerve root. The neurologist may also recommend treatment options, such as physical therapy, medication, or surgery.
Treatment Options
The treatment options for a compression neuropathy of the left C6 nerve root depend on the severity of the symptoms and the patient's overall health. Some treatment options include:
- Physical therapy: Physical therapy can help to improve the strength and range of motion of the left hand.
- Medication: Medications, such as anti-inflammatory drugs or steroids, can help to reduce inflammation and pain.
- Surgery: Surgery may be necessary in some cases to relieve the compression of the nerve root.
The goal of treatment is to relieve the symptoms and improve the patient's function. The specific treatment plan will be individualized for each patient.