Skill Checkup: A 59-Year-Old Man With Cervical/Lumbar Dorsalgia, Paresthesia in His Hands and Feet, and Muscle Weakness

Shaheen E. Lakhan, MD, PhD, MS, Med


March 31, 2023

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 59-year-old African American man in the United States presents with reports of gradually worsening cervical/lumbar dorsalgia, paresthesia and numbness/tingling in his hands and feet, and muscle weakness in his legs and arms for the past 2 months. He also reports difficulty with daily activities, including lifting himself from a seated position, climbing stairs, lifting objects overhead, and dressing. In addition, he complains of being clumsy, ie, dropping things as well as falling frequently. Physical exam reveals difficulty with ambulation, diffuse areflexia without wasting, allodynia, and hypotonia. The patient has a positive Romberg test. His medical history is otherwise unremarkable. Laboratory testing is performed: complete blood count, sedimentation rate, antinuclear antibody, biochemistry profile, thyroid studies, glycated hemoglobin, serum free light chain assay, as well as serum and urine immunoelectrophoresis all come back within normal range.


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