Frequency of classical hand signs in cervical spondylotic myelopathy: A prospective cross-sectional observational study

Why This Matters

Cervical spondylotic myelopathy can cause progressive neurological disability, sometimes beginning with subtle changes in hand coordination or dexterity before more obvious neurological impairment develops. Recognizing these findings during routine clinical examination is important because early symptoms may be mistaken for isolated musculoskeletal or peripheral nerve problems.

Although MRI remains central to evaluating cervical spinal cord compression, bedside neurological examination can raise suspicion of myelopathy and help determine when further investigation is warranted.

This study examined how frequently classical hand signs occur in patients with cervical myelopathy and whether these findings are associated with the severity of neurological disability.

What the Research Found

This prospective cross-sectional observational study evaluated 102 adults with clinically suspected and MRI-confirmed cervical spondylotic myelopathy at a tertiary spine center.

Researchers assessed classical neurological hand signs, measured grip strength using a hand dynamometer, and compared examination findings with functional severity measured by the modified Japanese Orthopaedic Association (mJOA) score and Nurick’s scale.

Classical hand signs were common, occurring in approximately 72% of patients, and were moderately associated with greater functional impairment.

KEY POINTS

• At least one classical hand sign was present in 71.6% of patients. Nearly three out of four patients demonstrated a recognizable neurological hand finding.
• Hoffmann’s sign was the most frequently identified finding. It was positive in 48.0% of patients, followed by the finger escape sign in 43.1% and an abnormal grip-and-release test in 16.7%.
• Gait imbalance and impaired hand dexterity were common presenting symptoms. Gait imbalance occurred in 73.5% of patients, while 56.9% reported impaired hand dexterity.
• Functional impairment was substantial in many patients. Approximately 41% had mJOA scores of 10–12, while 55% had Nurick grades of 3–4.
• Classical hand signs were moderately associated with greater neurological disability. Patients with more prominent hand-sign findings tended to have worse neurological function and greater functional impairment.

Recognizing these neurological findings may help clinicians identify patients with possible cervical myelopathy who warrant further investigation, including consideration of cervical MRI.