A 52-Year-Old Man Comes to the Office Due to Upper

A 52-year-old man comes to the office due to upper extremity weakness and pain in his shoulders and upper back since shoveling snow 3 weeks ago.  His left arm also has started to feel heavy, and he has difficulty dressing and undressing because he lacks the strength to pull clothes over his head.  The patient has not had similar symptoms before and recalls no other trauma to the area.  He has a history of hypertension and hypothyroidism.  Vital signs are within normal limits.  Physical examination of the shoulder joints shows no deformity, and passive range of motion is full with no pain.  There is moderate weakness of left shoulder abduction, but strength in the other muscle groups is normal.  Decreased sensation to light touch and pinprick is present on the left lateral forearm.  The remainder of the examination shows no abnormalities.  Which of the following is the most appropriate next step in evaluation of this patient's symptoms?

A) CT scan of the brain
B) MRI of the cervical spine
C) MRI of the shoulder joint
D) Nerve conduction studies
E) TSH and creatine kinase levels

Correct Answer:

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