Cervical spondylotic myelopathy: arm stiffness and unsteady gait
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An 81 year old woman presented to her general practitioner with stiffness in her left arm and hand. The stiffness started a year ago but had recently begun to affect her other hand and to prevent typing. The stiffness was present at all times. She reported no pain or swelling in any limb. She also had difficulty walking and was unsteady on her feet. This had been present for two years. She used a walking frame and had a stair lift at home. She reported no tingling, numbness, or neck discomfort. She described increasing nocturia and stress incontinence in the past three months, with no bowel symptoms.
Neck examination showed good range of movement, with no pain or tenderness. Neurological examination of the upper limbs showed wasting of the left thenar eminence and the dorsal interossei bilaterally. Tone was increased in both arms. Power was reduced bilaterally in the intrinsic