He recalls that the pain began insidiously as a dull ache in the posterior left neck and upper shoulder area. Over the course of several weeks the pain progressed to involve his entire left upper limb. There is an associated sensation of numbness affecting the entire left hand. Occasional numbness is noted along the left arm and forearm in no discrete distribution.
Weakness is described for the entire left upper limb.
The pain is constant in nature but is particularly annoying at night, as it prevents him from sleeping through the night. He is presently not employed because of his arm pain. The patient had a previous radiculopathy on the right side which was treated with a C5 laminectomy and discectomy in 1994. He is on no medication at this time and is not being treated for any medical conditions. Prior to continuing, please develop a differential diagnosis and list each possible diagnosis in order of likelihood.