Working Diagnosis:
Bilateral sensorimotor radial mononeuropathies of unknown clinical significance.

Treatment:
Neurologic consultation for concerns of possible underlying diffuse neuromyopathic process was sought. No further workup was advised, and no etiology was ascertained. The patient is participating in a physical therapy program to address his strength deficits.

Outcome:
The patient continues to engage in his typical daily routines without functional limitation. Interval follow-up to monitor for progression has been advised.

Author's Comments:
The insidious onset of the patient’s painless weakness and his marked atrophy suggests against an acute compressive neuropathy as can be seen from prolonged operative positioning. His history of end-stage renal disease and subsequent immunosuppressive therapy following his transplant could be contributing factors to his clinical presentation; however, an underlying diffuse length dependent neuropathy was not identified on electrodiagnostic testing. The unexplained presence of upper motor neuron findings was the most concerning aspect of this patient’s case. The correlation, if any, with his bilateral sensorimotor radial mononeuropathies remains unclear. Nonetheless, ongoing monitoring and further work-up is indicated. This may include interval electrodiagnostic evaluation with comparison to his initial study.

Editor's Comments:
This is an interesting case presentation in a patient with possible medical comorbidities. Electromyography showed important abnormalities and in-office ultrasound was also helpful to visualize the effected muscles. Future monitoring may help to elucidate a clear etiology.

References:
Jacobson JA. Fundamentals of Musculoskeletal Ultrasound. 2nd ed. Elsevier Saunders; 2013.
Kimura J. Electrodiagnosis in Diseases of Nerve and Muscle: Principles and Practice. 3rd ed. New York City: Oxford University Press; 2001.
Perotto A. Anatomical Guide for the Electromyographer. 5th ed. Springfield: Charles C. Thomas - Publisher, Ltd.; 2011.
Preston DC, Shapiro BE. Electromyography and Neuromuscular Disorders. 3rd ed. Elsevier; 2013.

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