Postoperative brachial plexopathy is a rare but recognized complication of cervical spine surgery, typically resulting from intraoperative traction, positioning, or compression of the brachial plexus. We present the case of a man in his 50s with poorly controlled diabetes who developed acute, severe upper-extremity pain, weakness, and numbness two days after a multilevel anterior cervical discectomy and fusion for cervical stenosis. Examination revealed C5-C6 deficits, and electromyography demonstrated active denervation in multiple muscles innervated by these roots. Magnetic resonance imaging (MRI) of the brachial plexus showed mild edema, while shoulder imaging revealed extensive rotator-cuff pathology. This case underscores the diagnostic challenge of distinguishing postoperative brachial plexopathy from simultaneous musculoskeletal disease and highlights the importance of early electrodiagnostic testing, careful imaging assessment, and timely management in high-risk patients.

BackgroundHand edema is a common post-stroke complication that negatively affects function and quality of life. However, interventions for hand edema remain limited.ObjectiveIn this study, we investigated whether contralateral resistance handgrip exercises performed with the non-paretic hand could immediately and sustainably reduce hand edema in patients with stroke.MethodsThis study used a B-A-B single-case design to explore the effects of the intervention in inpatients more than 3 months post-stroke. During the two 8-day intervention phases, the participants performed rhythmic handgrip exercises at 30% of the maximum voluntary contraction for 5 min daily as part of their occupational therapy sessions. A baseline phase without intervention was interposed. The hand volume was measured by using water displacement before and after exercise sessions to assess immediate and sustained effects.ResultsFour inpatients with paretic hand edema (93-110 days poststroke) participated in this study. Contralateral handgrip exercise resulted in immediate reduction in paretic hand edema in three of the four patients; however, only one patient showed a sustained effect. The intervention was simple and feasible, with responses varying across individuals.ConclusionsThis small single-case study suggests that contralateral handgrip exercise may contribute to reducing hand edema in some patients; however, its sustained benefits remain uncertain. This low-cost approach may serve as a candidate adjunct intervention in rehabilitation, particularly when paretic limb movements are limited. However, given the exploratory nature of this small single-case study, further investigation with larger samples and more rigorous designs is warranted.

Amiodarone is a widely used antiarrhythmic agent. Pulmonary toxicity is its most feared non-cardiac complication and is classically associated with high doses and prolonged duration of therapy. We report a case of early-onset amiodarone pulmonary toxicity (APT) developing after approximately one month of standard-dose amiodarone therapy (400 mg/day) in the setting of concurrent decompensated heart failure with preserved ejection fraction (HFpEF), which substantially complicated the diagnostic evaluation. A 71-year-old male with paroxysmal atrial fibrillation, nonischemic cardiomyopathy, and multiple comorbidities was initiated on amiodarone 400 mg/day in April. Within one month, he developed progressive dyspnea on exertion and productive cough. He presented to the emergency department in September with acute hypoxic respiratory failure (SpO₂ 86% on room air), weight gain, and bilateral lower extremity edema approximately five months after symptom onset. CT of the chest demonstrated bilateral ground-glass and consolidative opacities with upper lobe predominance and interlobular septal thickening. The initial working diagnosis of decompensated HFpEF was supported by elevated BNP and peripheral edema; intravenous furosemide led to the resolution of edema but no improvement in oxygenation. APT was subsequently suspected, and intravenous methylprednisolone was initiated, resulting in marked clinical improvement. The patient was discharged on room air on a prolonged prednisone taper. At the three-month follow-up, he demonstrated complete symptomatic resolution, marked radiological improvement, and normalization of BNP. This case adds to the existing evidence that clinically significant APT may occur at standard maintenance doses and within a shorter timeframe than traditionally recognized. Coexistent HFpEF poses a major diagnostic challenge given the substantial overlap in clinical and radiological features. The possibility of concurrent rather than competing pathology should always be considered. Clinicians should maintain a high index of suspicion for APT in any patient on amiodarone with progressive respiratory symptoms, irrespective of dose or duration of exposure.

Prompt, accurate identification of inflammatory arthritis can reduce patient morbidity and health care costs. However, internal medicine residents often do not receive adequate training in how to conduct an effective hand musculoskeletal examination. We created a short interactive workshop to teach the hand exam using our low-cost, easy-to-make 3-dimensional hand model for inflammatory arthritis.