If necessary, revise your differential diagnosis based on the additional clinical history. The negative family history makes muscular dystrophy and scapuloperoneal syndrome unlikely diagnoses. There is no history of precipitating factors often associated with neuralgic amyotrophy. The physical examination reveals winging of the right scapula at rest. Muscle bulk is otherwise normal and symmetric.
Strength is normal in the upper and lower extremities.
There is no facial weakness. Sensation is intact in the upper extremities. Muscle stretch reflexes are normal and symmetric. Cervical range of motion is normal and pain-free. Spurling maneuver is negative.