Omer Jamshed Khan.
Importance of Clinical Examination & Electrodiagnosis in Diagnosing Upper Limb Neurological Disorders.
Int J Rehab Sci Jan ;06(01):34.

Background: Peripheral neurological disorders affecting the upper limbs, e.g radiculopathies, nerve injuries, brachial amyotrophies etc. can be quite challenging to diagnose. Given the complex nature of the shoulder girdle with its interdependence among different joints and structures, this task can become even more confusing. Differentiating between weakness and restriction, numbness and anesthesia is a challenging aspect. A wrong diagnosis can lead to disastrous results. A thorough clinical examination supplemented by electrodiagnosis must be carried out before making any diagnosis, especially those requiring radical procedures. Doctors does not give time to proper examination and technicians posing as doctors and trying to diagnose such complexities further complicates matters. moreover, the role of electrodiagnosis cannot be emphasized enough, but these have to be carried out by trained medical consultants. Objectives: To emphasize the importance of good and targeted clinical examination and avoiding serious lapses in neurological diagnosis this can lead to catastrophic results, even as irreversible as amputation. Methodology: In this observational study 6 patients were received in the department of rehab medicine for review of varying upper limb neurological disorders. They were previously diagnosed as having adhesive capsulitis, brachial plexus injury, cervical myelopathy, rotator cuff syndrome and factitious disorders respectively. One case labelled as non responsive brachial plexus injury was Advised amputation. The cases were re examined by the rehab consultant and electrodiagnostic testing using NCS/EMG was done to confirm the various diagnoses. It was found that all the patients had different diagnosis. The one who was advised amputation was a 12-year-old child with a simple psychiatric disorder. Similarly, other patients were diagnosed differently, proved by NCS/EMG and complete treatment overhaul was done. The entire trauma that the patients went through could have been avoided with good, targeted clinical examination. Results: The patients' diagnosis was changed and serious complications avoided Conclusion: Without proper history and clinical examination, neurological conditions can be easily missed or worse yet, misdiagnosed. Such a lapse can lead to serious complications.

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