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Final Program


Final Program

Electrodiagnostic / Neuromuscular Medicine

1635 - Chronic Cervical Radiculopathy and Upper Extremity Weakness Masking Amyotrophic Lateral Sclerosis: A Case Report

Friday, February 20, 2026
5:00 PM - 6:30 PM AST
Case Diagnosis: 83-year-old male with acute right wrist paralysis and bilateral hand weakness resulting from motor neuron disease.

Case Description: The patient presented with chronic neck pain and increased bilateral hand weakness for several months. He had a history of low back pain and peripheral neuropathy lasting 4 years with abnormal gait. His strength was 3/5 in bilateral lumbricals, 1/5 right wrist extension, (previously 4/5), and 4/5 left supraspinatus (previously 5/5).  He had moderate loss of neck range of motion and gross muscle atrophy in hand intrinsics, thenar and hypothenar eminence. Sensation to light touch was intact, but pinprick was diminished diffusely.  Previous electromyography (EMG) testing two years prior was notable for chronic C8 radiculopathy with ongoing axon loss. Cervical magnetic resonance imaging showed multilevel moderate foraminal stenosis and disc space narrowing. Repeat EMG was ordered and the patient was referred to neurology.

Discussions: New EMG showed active axon loss in thoracic paraspinals, and severe active and chronic motor axon loss affecting C5-T1 myotomes, consistent with evolving disorder of anterior horn cells. Amyotrophic Lateral Sclerosis (ALS) is a sporadic, progressive, degenerative disorder of cortical and spinal motor neurons that characteristically affects upper and lower motor neurons, but spares sensory and autonomic function. The presentation for motor neuron diseases can greatly vary and ALS is often overlooked in the spine medicine population because of its overlap in symptoms in patients with myelopathy and radiculopathy. Spondylosis can mimic ALS, especially clinically and in the EMG lab. This patient showed no symptoms of pseudobulbar affect or swallowing dysfunction.  We found no other cases in the literature demonstrating acute wrist paralysis as the prominent finding in ALS.

Conclusions: This case highlights the importance of the history and physical exam in spine patients with progressive wrist and hand weakness. Prompt diagnosis can allow for effective management in this patient population.