November 2018

A 56 Year Old Woman With Chin On Chest Deformity

 

History
A 56 year old woman presents to the outpatient clinic with 5 months of progressive difficulty holding up her head. She also complains of numb fingers, aching in her neck and biceps, and pain in her upper back and shoulders. These symptoms started and have been progressive since undergoing a C3-C4 anterior cervical discectomy and C3-C4, C4-C5 laminectomy.

Exam
Obvious chin-on-chest deformity
Cranial nerves II-XII are intact
Strength – 5/5 in upper and lower extremities
Sensation – intact to light touch in all 4 extremities
DTRs – 2+ throughout; bilateral Hoffman sign
Difficulty with heel and tandem gait

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Questions

 
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Your answers will be added to those already obtained and tabulated at the end of the month.