Can cervical spondylitis cause hand weakness?

From the Guidelines

Yes, cervical spondylitis can cause hand weakness due to compression of nerve roots or the spinal cord, leading to sensorimotor deficits. This condition involves degeneration of the cervical spine (neck) vertebrae and discs, which can result in narrowing of the neural foramina and compression of cervical spinal nerves, as described in the study by 1. The most common clinical presentation of cervical radiculopathy, a syndrome associated with cervical spondylitis, is a combination of neck pain with pain in one arm accompanied by varying degrees of sensory or motor function loss in the affected nerve-root distribution.

When nerve compression occurs, particularly at the C5-T1 levels which control arm and hand function, patients may experience weakness in the hands along with numbness, tingling, or pain, as noted in the study by 1. The weakness typically develops gradually and may affect grip strength, fine motor skills, and dexterity. Treatment options include anti-inflammatory medications, physical therapy focusing on neck strengthening and posture correction, and in severe cases, surgical decompression may be necessary.

Key points to consider in the management of cervical spondylitis-related hand weakness include:

• Early intervention to prevent permanent nerve damage
• Monitoring for red flag symptoms such as trauma, malignancy, or systemic diseases that may require immediate medical attention, as recommended by 1
• A thorough physical examination to assess sensory and motor function, although the diagnostic accuracy of physical examination tests in the setting of cervical radiculopathy is limited, as noted in the study by 1
• Imaging studies, such as MRI, may be considered in the presence of red flag symptoms or persistent symptoms despite conservative treatment, as suggested by 1.

Patients should seek medical attention if they notice progressive hand weakness, as prompt treatment can improve outcomes and reduce the risk of long-term disability, as implied by the study by 1.

From the Research

Cervical Spondylitis and Hand Weakness

• Cervical spondylitis can cause hand weakness, as evidenced by studies that have investigated the relationship between cervical spondylosis and hand muscle weakness 2, 3, 4.
• The "amyotrophic type of myelopathy hand" is a condition characterized by muscle wasting and motor dysfunction in patients with cervical spondylosis, which can lead to hand weakness 2.
• Hand weakness and wasting in the setting of mid-cervical spondylosis and disc herniation without radiological evidence for compression of the C8 or T1 roots has been reported 3.
• Cervical spondylotic myelopathy (CSM) is a neurologic condition that can cause decreased hand dexterity and gait instability, as well as sensory and motor dysfunction 4.
• The hallmark symptoms of CSM include decreased hand dexterity and gait instability, and patients with mild CSM may be treated surgically or nonoperatively, whereas those with moderate-severe disease are treated operatively 4.

Clinical Features and Diagnosis

• The main clinical features of the "amyotrophic type of myelopathy hand" include localized wasting and weakness of the extrinsic and intrinsic hand muscles, but not accompanied by either sensory loss or spastic quadriparesis 2.
• Magnetic resonance imaging (MRI) is the imaging modality of choice in patients with suspected CSM, but computed tomography myelography may be used in patients with contraindications 4.
• Patients with cervical spondylosis may experience intermittent neck pain, and neurologic symptoms can occur infrequently, usually in patients with congenital spinal stenosis 5.

Treatment and Management

• Surgical intervention is indicated for patients presenting with severe or progressive neurologic deficits, and anterior cervical approaches are generally preferred 5.
• Patients with mild CSM may be treated surgically or nonoperatively, whereas those with moderate-severe disease are treated operatively 4.
• Neck immobilization is a reasonable treatment in patients presenting with minor neurologic findings or in whom an operation is contraindicated, and can result in improvement in 30% to 50% of patients 5.