Clinical Reasoning: A 60-year-old man with arm weakness and numbness

A 60-year-old previously healthy man awoke with right arm pain and numbness. Opioids resulted in modest pain relief, but over the following weeks, the pain worsened. He began dropping things and had more difficulty writing, buttoning clothing, and opening jars. Cervical MRI demonstrated mild central canal stenosis and moderate foraminal stenosis at multiple levels, worse on the left. He received physical therapy and an epidural steroid injection for cervical radiculopathy, but his weakness worsened to near-paralysis of his right wrist and fingers.

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