Скачать или смотреть Can Compression of the Spinal Cord and Cervical Myelopathy Affect Hand Function?

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Cervical myelopathy is a form of neurological impairment caused by compression of the spinal cord within the cervical canal. MRI is usually the study of choice to diagnose cervical myelopathy. The natural history of cervical myelopathy is a slow, stepwise deterioration over time, with variable periods of stable neurological function.

Changes in hand dexterity and coordination are among the earliest signs, and these may be present in otherwise asymptomatic individuals. Progressive cervical cord compression can result in intrinsic muscle atrophy, weakness in grip and pinch, small finger escape, and impaired ability to perform rapid alternating movements.

A thorough history and physical examination are important given the often asymptomatic but progressive nature of cervical myelopathy. The lower cervical nerve roots, C8 to T1, are most severely affected. The clinical presentation is highly variable.

A typical patient with cervical myelopathy will complain of symmetric numbness and tingling in the extremities. The diffuse numbness in the hands is often misdiagnosed as carpal tunnel syndrome. A high index of suspicion is required because of the progressive deterioration. About 20% of patients with cervical myelopathy have no myelopathic signs on physical examination.

A myelopathic hand refers to the characteristic hand findings associated with cervical spine myelopathy. Patients develop hand clumsiness, decreased manual dexterity, difficulty manipulating objects, trouble buttoning or unbuttoning shirts, and frequently drop objects due to impaired grip.

The condition is most common in older patients, who may also complain of occipital headache. The myelopathic hand is characterized by difficulty with grip and release, loss of motor strength, sensory changes, intrinsic muscle wasting, finger escape sign, and spasticity.

Other clinical features include difficulty with hand dexterity, hyperreflexia, a positive Hoffmann’s sign, positive Romberg sign, and gait disturbance. Patients often feel unsteady on their feet.

The finger escape sign is elicited by asking the patient to hold the fingers extended and adducted. The small finger spontaneously abducts due to intrinsic muscle weakness. Additional digits may drift into abduction and flexion within 30 seconds.

The grip-and-release test is another useful clinical tool. A normal patient can make a fist and release it 20 times in 10 seconds. A myelopathic patient is unable to complete this task. In a positive grip-and-release test, the patient has trouble making a fist and fully extending the fingers, showing impaired coordination and dexterity.

A positive Hoffmann’s sign is demonstrated by snapping the distal phalanx of the middle finger, which leads to involuntary flexion of the other fingers. This is the most common physical examination finding.

Other findings may include a positive Babinski test, demonstrated by great toe extension, and sustained clonus lasting more than three beats.

The Hoffmann’s sign is reliable in about 60% of patients, Babinski in about 13%, and clonus in about 13%.

Cervical myelopathy is usually progressive, worsening over time, and rarely improves without surgery. Surgical treatment involves decompression and stabilization of the cervical spine. Early diagnosis and treatment are essential for achieving good outcomes.
Quizzes

1. Which imaging modality is most commonly used to diagnose cervical myelopathy?
A) CT scan
B) MRI
C) X-ray
D) Ultrasound
Answer: B) MRI
Explanation: MRI is the gold standard for diagnosing cervical myelopathy because it provides clear visualization of cord compression.

2. What is the typical progression of cervical myelopathy?
A) Rapid, with complete paralysis in days
B) Stepwise deterioration with stable periods
C) Immediate recovery without treatment
D) Fluctuating improvement and cure
Answer: B) Stepwise deterioration with stable periods
Explanation: The disease progresses slowly in a stepwise manner, with periods of stable neurological function.

3. Which cervical roots are most severely affected in cervical myelopathy?
A) C5–C6
B) C7–C8
C) C8–T1
D) T2–T3
Answer: C) C8–T1
Explanation: The lower cervical roots (C8–T1) are most vulnerable, affecting intrinsic hand muscles.

4. Early signs of cervical myelopathy often involve:
A) Visual loss
B) Loss of taste
C) Hand dexterity and coordination changes
D) Hearing impairment
Answer: C) Hand dexterity and coordination changes
Explanation: Fine motor tasks such as buttoning shirts and gripping are impaired early.

5. A patient with cervical myelopathy is often misdiagnosed with:
A) Stroke
B) Carpal tunnel syndrome
C) ALS
D) Multiple sclerosis
Answer: B) Carpal tunnel syndrome
Explanation: Diffuse hand numbness and tingling mimic carpal tunnel but are due to cord compression.