Can cervical spine disorders cause head and hand tremors?

Cervical Spine Disorders and Their Relationship to Tremors

Yes, cervical spine disorders can cause head and hand tremors, though this association is not widely recognized and is often misdiagnosed. The relationship between cervical pathology and tremor is supported by several case reports and clinical observations.

Mechanisms and Presentations of Cervical Spine-Related Tremors

• Cervical radiculopathy can present with dystonic tremor in addition to the more typical symptoms of brachialgia (arm pain), as documented in case reports where surgical decompression of cervical disc prolapse resulted in complete resolution of tremor symptoms 1
• Degenerative cervical myelopathy (DCM) has been associated with tremor symptoms that are often overlooked or misdiagnosed as other neurological conditions like Parkinson's disease 2
• Head tremor is commonly observed in cervical dystonia (68.4% of patients), with 34.6% of these patients experiencing tremor as one of their first symptoms 3
• Cervical spine disorders affecting the spinal cord can cause characteristic hand dysfunction, including tremor-like symptoms and inability to grip and release rapidly with the fingers (termed "myelopathy hand") 4

Diagnostic Challenges

• Tremor as a symptom of cervical spine disorders is often underrecognized, leading to misdiagnosis and delayed treatment 2
• The International Headache Society recognizes cervicogenic headache as a condition secondary to disorders of the cervical spine elements, which may present alongside other neurological symptoms 5
• Diagnosis of cervical spine-related neurological symptoms remains challenging due to:
  • Heterogeneous clinical presentations
  • Overlapping symptoms with other neurological disorders
  • Lack of definitive radiological findings
  • High prevalence of abnormal imaging findings in asymptomatic patients 5

Imaging and Diagnostic Approach

• MRI is the most sensitive imaging modality for detecting soft tissue abnormalities of the cervical spine that may be associated with neurological symptoms 5
• MRI has demonstrated pooled sensitivity and specificity of 90.6% and 95.4% respectively for detecting pathology in the cervical spine 5
• CT scanning may be useful but is less sensitive than MRI for detecting early marrow changes and soft tissue abnormalities that could affect neural elements 5
• Radiographs are frequently insensitive for detecting early disease, requiring 50-70% of bone destruction before reliable detection of pathological changes 5

Clinical Implications and Management

• Missed or delayed diagnosis of cervical spine disorders can lead to permanent neurological deficits in up to 29.4% of cases 5
• Surgical decompression has been shown to resolve tremor symptoms in cases where they are directly related to cervical radiculopathy or myelopathy 1
• The economic and quality of life impact of untreated cervical spine disorders with neurological complications is substantial, with lifetime care costs estimated at US$1 million per patient with tetraplegia 5, 6

Important Considerations

• When evaluating tremor, particularly when accompanied by neck pain or other cervical symptoms, cervical spine pathology should be considered in the differential diagnosis 1, 2
• Percutaneous interventions (such as nerve blocks) may serve both diagnostic and therapeutic purposes in confirming cervical origin of tremor symptoms 5
• The presence of hand tremor alongside cervical symptoms may indicate more extensive involvement of neural elements beyond simple mechanical neck pain 4, 1

Pitfalls to Avoid

• Attributing tremor solely to primary movement disorders without considering cervical spine pathology as a potential cause 2
• Relying exclusively on imaging findings without correlating with clinical symptoms, as abnormal imaging findings are common in asymptomatic individuals 5
• Delaying appropriate intervention for cervical spine disorders, which can lead to permanent neurological deficits 5
• Failing to recognize that tremor may be the presenting symptom of cervical myelopathy or radiculopathy rather than a separate neurological condition 1, 2