A clinical review of hand manifestations of cervical myelopathy, cervical radiculopathy, radial, ulnar, and median nerve neuropathies.

Cervical spondylotic myelopathy (CSM) is defined as compression of the spinal cord in the neck, resulting in problems with fine motor skills, hand numbness, pain or stiffness of the neck, and difficulty walking due to loss of balance. Brachial plexus (BP) neuropathies arise due to compression to any distal branches arising from C5-T1, whereas cervical radiculopathy involves compression at the nerve root in the neck. Such conditions can present with variable degrees of musculoskeletal pain, weakness, sensory changes, and reflex changes. The pronounced convergence in symptomatic manifestation within these conditions can pose a formidable challenge to clinicians, particularly in primary care. Thus, the primary objective of this paper is to enhance clarity and distinction among these pathological conditions. This objective is pursued through comprehensive delineation of the dermatomal and myotomal distributions characteristic of each condition. Furthermore, a meticulous examination is undertaken to elucidate physical indicators and maneuvers that exhibit a notably high sensitivity in detecting these conditions. Accurate diagnosis and treatment of each nerve pathology is important as long-term spinal cord compression and its roots may result in permanent disability and severely impact one's quality of life. As such, this systematic review serves as a guide that aids clinicians in differentiating the aforementioned conditions based on anatomy, physical exam findings, and imaging studies. Furthermore, this study aims to outline common peripheral nerve neuropathies in the upper extremities and ways to mitigate these pathologies using the least to most invasive treatment modalities.

Prevalence and Factors Associated With Fecal Urgency Among Patients With Ulcerative Colitis and Crohn's Disease in the Study of a Prospective Adult Research Cohort With Inflammatory Bowel Disease.

Background: In patients with ulcerative colitis (UC) and Crohn's disease (CD), this research examined the following: prevalence of fecal urgency (hereafter urgency), association of urgency with inflammatory bowel disease (IBD) symptoms and fecal calprotectin, and association between well-being and urgency. Methods: In this cross-sectional study from the Study of a Prospective Adult Research Cohort with IBD, urgency was categorized as none, mild, and moderate-severe. We examined the prevalence of urgency, association of urgency with IBD symptoms and fecal calprotectin (in a subset) using multinomial logistic regression, and association of well-being (not feeling well vs generally well) with urgency using logistic regression. Results: Among 576 UC patients, 31.4% reported mild and 28.1% moderate-severe urgency. Among 1330 CD patients, 33.8% reported mild and 31.4% moderate-severe urgency. In UC, moderate-severe urgency was associated with: increased average bowel movements/day [odds ratio (OR) 1.23; 95% confidence interval: 1.09, 1.23], increased stool frequency relative to normal (OR, 9.95; 95% CI: 3.21, 30.87), rectal bleeding (OR, 3.36; 95% CI: 1.79, 6.34), moderate-severe abdominal pain (OR, 17.5; 95% CI: 5.38, 56.89), and calprotectin ≥ 250 µg/g (OR, 4.36; 95% CI: 1.50, 12.66). In CD, moderate-severe urgency was associated with: increased average bowel movements/day (OR, 1.23; 95% CI: 1.14, 1.34), increased stool frequency relative to normal (OR, 7.57; 95% CI: 3.30, 17.34), rectal bleeding (OR, 1.77; 95% CI: 1.13, 2.78), and moderate-severe abdominal pain (OR, 7.52; 95% CI: 4.31, 13.14). Reduced well-being was associated with moderate-severe urgency in both UC (OR, 4.20; 95% CI: 1.69, 20.40) and CD patients (OR, 2.52; 95% CI: 1.51, 4.22). Conclusions: Urgency was common and associated with symptoms and biomarkers suggesting active IBD and reduced well-being.