Solomon Sallfors: Ambulatory Morning Report 1: ARM PAINChief Complaint: Arm PainHPI: 54 yo man with insignificant PMHx presents with arm pain for 1 year. He injured his right arm at work while carrying a heavy object on his shoulder. Its weight shifted and exerted a downward and lateral force on his shoulder. The injury was very painful. He took one day off work to rest the arm. Over the past year, he has had constant arm pain, dull in character with intermittent exacerbations of sharp pain, which comes on with suddenly with work and at rest, exacerbations mostly lasting less than an hour and rated 10/10. Exacerbations are associated with shocking pain from paraspinal region down lateral upper arm. Patient also discloses multiple times in which his arm becomes numb and goes to sleep requiring him to conduct arm maneuvers, which relieve this numbness. Patient refuses pain medications. He comes to the clinic make sure theres nothing serious going on. Meds: None. Surgeries: None. Allergies: None. FMHX: HTN, HLD. PMHx: HTN,HLD. SOCIAL: No Alc/tob/drugs. Married with 2 adult children. Employed as handyman at church >10yrs. ROS: Neg except as in HPI.PE: Vitals: 135/85. 75HR 12RR O2SATs 98% Temp 89.9. Gen: Well dev, well nourished man who looks his stated age, greater than average muscle mass with some obvious excess body fat, well kept and appropriately dressed, in no apparent distress. Neuro: Normal affect, thought processes, and general behavior. CN2-12 grossly intact. 5/5 muscle strength throughout. Reflexes triceps, biceps, and brachioradialis+2. Sensation is grossly intact. No numbness, spasticity, abnormal movements or tremors, or rigidity. Musculoskeletal: Nl size, tone, and ROM in major muscle groups, including right upper extremity, with some increased tone in the paraspinal region on the right around C5-7. Special Tests: Neg including drop arm, empty can, left-off, Yergason's, Hawkins, AC joint tenderness, Spurlings, Speeds, Apprehension. PSYC: no anhedonia, no worthlessness. Other systems normal.Labs: None. Diagnosis: Cervical radiculopathy. Etiology disc herniation (acute onset, likely C5) vs cervical spondylosis (less likely chronic condition).Work UP: MRI. Treatment: For patients with cervical radiculopathy who have clear radicular pain and symptoms of paresthesia, numbness, or nonprogressive neurologic deficits, initial therapy is conservative: NSAIDs, avoidance of provocative activities, and poss short course of oralprednisoneif pain is severe. With pain controlled, patient can start physical therapy.1/3 of patients will have symptoms recur, after which conservative therapy should be restarted. Surgery is an option with motor weakness impairing function or pain after 6-12 weeks.Our Patient: Refused medications. Consented to MRI. He will follow up with physical therapy.