1306 - Double Trouble: Concurrent Neuralgic Amyotrophy and Cervical Radiculopathy

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

DW

Derrick P. Williams, Jr., MD

Resident Physician
UTHealth Houston
HOUSTON, Texas, United States

Co-Author(s)

KP

Kemly Philip, MD, PhD, MBE

Attending Physician
UTHealth Houston
Houston, Texas, United States

Submitter(s)

DW

Derrick P. Williams, Jr., MD

McGovern Medical School
HOUSTON, Texas, United States

Case Diagnosis: Concurrent left-sided neuralgic amyotrophy (NA) and acute on chronic cervical radiculopathy (CR).

Case Description: 54 year-old male presented with acute left neck and shoulder pain with forearm paresthesias, preceded by excess exertion and viral illness months earlier. Initially diagnosed with left CR, he received cyclobenzaprine, meloxicam, oral steroids, and physical therapy (PT). At follow-up, he reported left arm atrophy, weakness, and worsening pain consistent with NA. Electromyography demonstrated both left brachial plexopathy and C5-C6 radiculopathy. MRI showed multilevel cervical foraminal stenosis and denervation edema in the left rotator cuff. Multidisciplinary consensus identified dual pathology of NA likely triggered by overuse in the setting of chronic CR. He initially improved with PT and medications, however, a subsequent fall worsened his left arm radicular pain. Repeat imaging showed worsened multilevel foraminal stenosis. Cervical transforaminal epidural steroid injection (TFESI) relieved radicular pain, while PT supported NA recovery.

Discussions: NA is often preceded by a trigger and presents with rapid onset of pain, followed by proximal weakness and muscular atrophy. In contrast, CR presents with dermatomal numbness and myotomal weakness. Overlapping symptoms can complicate diagnoses. NA management is primarily supportive while CR may require targeted injections for refractory pain. Compared to CR, NA demonstrates slower, less predictable recovery with higher risk of residual deficits. Electrodiagnostics, advanced imaging and multidisciplinary discussion, including spine surgery, guided the successful diagnoses and treatment of this patient’s co-occurring NA and CR.

Conclusions: This case illustrates the diagnostic and therapeutic complexity of overlapping NA and CR. TFESI treated the CR, while NA responded to PT resulting in functional improvement and avoidance of surgery. In patients with suspected concurrent NA and CR, detailed history, physical exams, electrodiagnostics, imaging, and multidisciplinary discussions are important in guiding diagnosis and management, limiting unnecessary interventions, setting realistic prognostic expectations, and ultimately enhancing function and quality of life.