New clinical sign of cervical myelopathy: Wazir hand myelopathy sign

Wazir NN, Kareem BA
Correspondence: Dr Nayyer Naveed Wazir, nayyernaveed_wazir@imu.edu.my

ABSTRACT
Introduction Cervical spondylotic myelopathy (CSM) represents a spectrum of pathologies with progressive compression of the spinal cord. The clinical signs and symptoms play a key role in diagnosis. The characteristic hand myelopathy signs are of significant clinical importance. The aim of this descriptive study was to report a relatively easy to elicit new hand myelopathy sign. The basis for this is finger and wrist flexor disinhibition, which is used for the spinal specificity of cord compression at or above the C5/6 level.
Methods The new clinical test was conducted in 68 patients with a mean age of 62 (range 54–68) years. The patients were divided into two groups according to their level of stenosis. Group 1 (n is 58) patients had stenosis at or above the C5/6 level, while Group 2 (n is 10) patients had stenosis at or below the C6/7 level. All these patients were clinically evaluated and their level of stenosis was confirmed using magnetic resonance imaging.
Results The Wazir sign was observed and well reproducible in 54 (93%) patients (Group 1); the myelopathy signs of three patients were positive (Hoffman’s sign, finger escape and ten-second test). In Group 2, the Wazir sign was not reproducible, but the myelopathy signs were also positive in three patients.
Conclusion The Wazir hand myelopathy sign was found to be consistently present in our patients, in addition to the other hand myelopathy signs.

Keywords: cervical myelopathy, hand myelopathy signs
Singapore Med J 2011; 52(1): 47-49