The physical examination should focus first on trying to localize the problem anatomically to determine if it is uni- or multifocal. Then a search should be made for any possible focal nerve lesion in the asymptomatic left upper limb. Multifocality, particularly if it is bilateral, would shift the weight of the evidence away from compression neuropathy. There is no Spurling sign. Slight to moderate weakness is present in the right upper limb in radial wrist extension, radial wrist flexion, forearm pronation, and flexion of the thumb, index and middle fingers.
Profound weakness is present in ulnar wrist extension and extension of all digits.
No weakness is found in ulnar wrist flexion or flexion of the distal phalangeal joints of the ring and little fingers. Proximal to the elbow, strength appears intact including the shoulder girdle muscles. Muscle strength is also intact in the left upper limb and both lower limbs. The biceps and triceps reflexes are present and symmetric, as are the muscle stretch reflexes in the lower limbs. A mild deficit of appreciation of pain and light touch is present over the tip of the right middle finger.