Clinical Reasoning: Adult Patient Presenting With Spine Pain Following a Motor Vehicle Accident

Area of Science:

• Neurology
• Clinical Electrophysiology
• Myology

Background:

• A 52-year-old woman presented with refractory spine pain post-trauma.
• Complex medical history including consanguinity and normal initial limb EMG.
• Spine imaging showed paraspinal muscle fatty degeneration and atrophy.

Observation:

• Clinical examination lacked specific findings.
• Mildly elevated creatine phosphokinase levels were noted.
• Follow-up EMG of paraspinal and trunk muscles revealed myopathic abnormalities.

Findings:

• Electromyography (EMG) demonstrated myotonic discharges, fibrillations, positive sharp waves, and myopathic motor unit potentials in paraspinal muscles.
• These neurophysiological findings were key to diagnosing a myopathic disorder.
• The diagnostic process confirmed a rare, treatable myopathy.

Implications:

• Highlights the diagnostic value of paraspinal muscle EMG in complex pain cases.
• Emphasizes the importance of targeted neurophysiological evaluation for diagnosing myopathies.
• Facilitates early diagnosis and treatment of rare myopathies, improving patient outcomes.