A 12-Year-Old With Urinary Retention Who Can't Grasp Objects

Liana Meffert; Daniel Miller, MD


April 18, 2022

Physical Examination and Workup

Upon physical examination, the patient appears anxious and in distress. He holds his neck in a partially flexed position. His heart rate is 76 beats/min, his blood pressure is 143/102 mm Hg, his respiration rate is 15 breaths/min, and his temperature is 97.5 °F (36.4 °C).

The patient exhibits tenderness through T2-T10 and can shrug his shoulders but is unable to abduct his arms. He exhibits no tenderness over the acromioclavicular joint or any palpable step-off deformity on examination. Decreased upper-extremity strength is evident bilaterally. Deltoid strength is 0/5 on the right and 2/5 on the left; biceps strength is 0/5 on the right and 3/5 on the left; and triceps strength is 0/5 on the right and 3/5 on the left. Grip strength is 2/5 for the right upper extremity. He has no loss of temperature or other sensation in the upper extremities. The patient has normal reflexes and strength in both lower extremities. He is able to walk without assistance but has difficulty in raising himself from a lying to a standing position.

He has a postvoid residual bladder volume of 1 L. The results of a complete blood cell count and a basic metabolic panel are within normal limits.

An MRI of the cervical and thoracic spine with and without contrast is ordered.


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