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Abstract

Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction in the elderly population. It is a degenerative disease that classically presents with fine motor dysfunction of the hands and gait instability. These symptoms can easily be masked by old age, complex medical history, and more benign diseases. We describe the case of a 67-year-old male who was referred to orthopedic surgery for bilateral hand numbness and weakness attributed to carpal tunnel syndrome (CTS). The patient had trouble ambulating, rhythmic clonus in his ankles, and a bilateral positive Hoffman sign resulting in a referral to neurosurgery for an emergent spinal cord decompression. To our knowledge, few case reports exist demonstrating how cervical myelopathy can mimic more benign peripheral nerve diseases such as CTS. We describe how difficult early recognition can be, as well as the importance of primary care doctors maintaining a high degree of suspicion for a disease that has nonspecific examination findings and can easily mimic more benign processes.

Introduction

The carpal tunnel is located at the base of the palm and is bound by eight carpal bones and the transverse carpal ligament [1]. Residing within the carpal tunnel are nine flexor tendons as well as the median nerve [1]. Compression of the median nerve as it courses through the carpal tunnel into the wrist results in carpal tunnel syndrome (CTS). CTS is responsible for 90% of all nerve entrapment neuropathies and is prevalent in about 3.7% of the general population [2,3]. Clinically, patients with CTS present with decreased sensation in the median nerve distribution distal to the carpal tunnel. On examination, patients exhibit hand pain, numbness, and tingling of the thumb, index, middle, and radial side of the ring finger [4]. Nonsurgical management of CTS includes hand bracing, splinting of the wrist, oral steroids, nonsteroid anti-inflammatory drugs, and local injection of corticosteroids [2]. Surgical management of CTS consists of decompressing the carpal tunnel by division of the transverse carpal ligament [2].

More serious neurological diseases such as cervical spondylotic myelopathy (CSM) can be misdiagnosed because of more prevalent diseases such as CTS. CSM is the most common type of spinal cord dysfunction in patients older than 55 years and the most common cause of acquired spasticity later in life [5,6]. CSM is a spinal cord injury caused by compression of the spinal cord within the spinal canal [7]. Clinically, patients can present with both upper and lower neuron signs such as hyperreflexia, the Hoffmann sign, clonus, fasciculations, and the Babinski sign [8]. Patients may present with weakness and clumsiness in their upper extremities with associated difficulty performing everyday tasks [7]. Lower extremity weakness is also common among these patients and presents as a broad-based unsteady gait [7]. Severe CSM is a surgical emergency that requires decompressive surgery...(More)

For more info please read, Cervical Spondylotic Myelopathy Presenting as Peripheral Nerve Disease: A Case Report, by Cureus