We noted Dr Selmonosky's useful comments on the importance of
considering the presence of peripherally placed entrapment in patients who
present with upper limb symptomatology and harbor cervical degeneration.
We would like to add that the diagnostic dilemma is equally pertinent in
patients with cervical myelopathy, who, on occasions can present
exclusively with numb clumsy hands reminiscent of carpal tunnel syndrome.
The presence of hyper-reflexia in the myelopathic patients is very
important in distinguishing between these pathologies, although, on
occasions proceeding to electrophysiological testing is necessary.
Competing interests: No competing interests