Module 2, General Orthopaedist Level
This 16 year old black male presented with the chief complaint of left
scapular winging and weakness of the left arm. Patient also complained
of the inability to abduct arms beyond the horizontal position. He had
also noticed increasing atrophy of the left arm. He was active in sports
and played football but was unable to play basketball. Facial characteristics
included a transverse smile, inability to purse lips or whistle, and inability
to close his eyes completely. Active abduction of the shoulders was approximately
90 degrees with a normal passive ROM. Motor strength of (L) UE was 4/5
except deltoid which as 5/5. Both scapulae were elevated and medially rotated
with marked winging noted with attempted abduction. EMG and NCS revealed
a myopathic process.
Question 2A
The
next step in the work up is a muscle biopsy which would be expected to
provide the definite diagnosis.
Question 2B
An
aggressive program of muscle strengthening is the first treatment recommendation.
Question 2C
CPK
is ordered and found to be normal. This is consistent with the electromyography
(EMG) and nerve conduction studies (NCS).
Question 2D
Weakness
was noted in the tibialis anterior bilaterally. An EMG and NCS should be
obtained of the lower extremities.
Question 2E
A
hearing test should also be obtained.
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