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This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations.
A 37-year-old woman presents with a two-week history of severe neck pain radiating to her left shoulder girdle and extending to the arm, forearm, and dorsum of the hand. She reports having had no fever, weight loss, leg weakness, or urinary or bowel dysfunction. Physical examination reveals weakness of her left triceps, finger extensors, and wrist flexors, as well as hypoesthesia of
The Clinical Problem
Epidemiology
Causes and Pathophysiological Features
Strategies and Evidence
Clinical Diagnosis
Laboratory Studies
Imaging
Electrodiagnostic Studies
Treatment
Nonsurgical Management
Surgery
Surgical vs. Nonsurgical Management
Areas of Uncertainty
Guidelines
Summary and Recommendations
Source Information
From the Divisions of Rheumatology (S.C.) and Neurosurgery (M.G.F.), Toronto Western Hospital, University Health Network; and the Departments of Medicine and Surgery, University of Toronto (S.C., M.G.F.) all in Toronto.
Address reprint requests to Dr. Carette at Toronto Western Hospital, EW1-422, 399 Bathurst St., Toronto, ON M5T 2A8, Canada, or at simon.carette@uhn.on.ca.
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