Question

a 45-year-old construction worker describes aching neck pain radiating to the right arm, with numbness in the little finger. the symptoms are aggravated by neck extension. which of the following is the most likely diagnosis?

thoracic outlet syndrome
cervical radiculopathy
peripheral neuropathy
carpal tunnel syndrome

Explanation:

1. Thoracic outlet syndrome: Typically causes pain/numbness in the whole arm/hand, not isolated to the little finger, and is aggravated by arm positioning (not neck extension).
2. Cervical radiculopathy: Matches the presentation: neck pain radiating to the arm, numbness in a specific dermatome (the little finger corresponds to C8 nerve root), and symptoms worsened by neck extension which narrows the cervical neural foramina and irritates the affected nerve root. This is common in workers with neck strain.
3. Peripheral neuropathy: Usually causes symmetric numbness/tingling in hands/feet, not isolated to one finger with neck pain.
4. Carpal tunnel syndrome: Affects the median nerve, causing symptoms in the thumb, index, middle, and half of the ring finger, not the little finger, and is unrelated to neck movement.

Answer:

Cervical radiculopathy