Clumsy Hands & Balance Issues? Identifying Cervical Myelopathy Symptoms

The "Silent" Spine Condition You Shouldn't Ignore

Neck pain is common, but what happens when your symptoms aren't just pain?

Imagine trying to button your shirt, but your fingers feel thick and clumsy. Or you're walking down the street, and you feel unsteady, like you've had a few drinks, even though you haven't. These aren't just signs of aging—they are the hallmark warning signs of Cervical Myelopathy.

In my practice in Hyderabad, I often see patients aged 50 and above who have been treated for "general weakness" or "arthritis" for months, while their spinal cord was slowly being compressed. This delay is dangerous.

Cervical Myelopathy occurs when the spinal cord in your neck is squeezed or compressed. Unlike a pinched nerve (radiculopathy) which causes pain, myelopathy causes loss of function. This is a serious condition that requires prompt evaluation by a neurosurgeon.

Myelopathy vs. Radiculopathy: What's the Difference?

It's crucial to understand the difference because the urgency is different. Many patients confuse the two.

Cervical Radiculopathy (Pinched Nerve Root)

• Target: Compression of a nerve root exiting the spine.
• Symptoms: Sharp, shooting pain down the arm, numbness in specific fingers (thumb or pinky).
• Urgency: Moderate. It is painful but rarely dangerous. It often heals with time, medication, and physiotherapy.
• Treatment: 80-90% of cases resolve without surgery.

Cervical Myelopathy (Compressed Spinal Cord)

• Target: Compression of the main spinal cord.
• Symptoms: Clumsiness, balance issues, weakness in hands and legs, stiff walking.
• Urgency: High. The spinal cord does not heal well. Compression causes cell death in the cord.
• Treatment: Surgery is almost always required to stop paralysis.

The Classic Warning Signs (The "Triad")

If you experience these symptoms, do not wait. The damage can become permanent if ignored.

1. Clumsy Hands (Loss of Fine Motor Skills)

This is often the first sign. You might notice:

• Difficulty buttoning shirts or clasping jewelry.
• Dropping objects like coffee cups, pens, or keys.
• Handwriting becoming messy or difficult (micrographia).
• Difficulty typing or using a smartphone touch screen.
• Numbness that feels like "gloves" on your hands.

Patients often tell me, "Doctor, my hands just don't listen to me."

2. Balance and Gait Issues (Myelopathic Gait)

The spinal cord carries signals to your legs. When compressed, these signals get "fuzzy."

• Unsteady Walking: Needing to hold onto walls or furniture while walking.
• Proprioception Loss: Feeling like you are walking on cotton, foam, or uneven ground.
• Darkness Difficulty: Balance worsens significantly when you close your eyes or walk in the dark (washing your face in the shower becomes scary).
• Spasticity: Legs feeling heavy, stiff, or "robotic." Others may notice you shuffling or walking with a wide stance to keep balance.

3. Bowel and Bladder Changes (Late Stage)

In advanced cases, you may have urgency (need to rush to the bathroom) or difficulty initiating urination. This is a Red Flag for severe compression and requires emergency attention.

The "Grip and Release" Self-Test

While only an MRI can diagnose myelopathy, this simple clinical test can check for hand coordination issues.

1. Hold your hand out in front of you.
2. Make a tight fist, then fully extend your fingers.
3. Do this as fast as you can for 10 seconds.

Result: A normal adult can usually do this 20 times in 10 seconds. If you struggle to do it 10-15 times, or your fingers start to "lock up" or drift (specifically the pinky finger drifting away), it is a positive sign for myelopathy.

Why You Might NOT Have Neck Pain

Here is the scary part: Many patients with severe myelopathy have very little neck pain.

Because the pressure is on the cord (which transmits signals) rather than the pain-sensitive structures like the facet joints or muscles, the "silent" progression can mask the severity of the problem. Do not rule out a spine problem just because your neck doesn't hurt. If your legs are weak, the problem might be in your neck.

The Diagnostic Journey: How We Confirm Myelopathy

If your clinical history suggests myelopathy, we perform specific neurological tests in the clinic:

• Hoffmann’s Sign: Flicking the middle fingernail. If the thumb and index finger twitch involuntarily, it suggests cord compression.
• Romberg Test: Standing with feet together and eyes closed to check for balance loss.
• Hyperreflexia: Checking if your knee or ankle reflexes are exaggerated (hyperactive).

The MRI: The Gold Standard

To confirm the diagnosis, an MRI of the Cervical Spine is essential. It provides two critical pieces of information:

1. Compression Severity: How tight is the canal? Is the cord flattened?
2. Myelomalacia (Cord Bruising): This appears as a bright white spot inside the spinal cord on T2-weighted images. This indicates that the cord is not just squeezed but is undergoing cellular damage.

Treatment Options: Why Waiting is Dangerous

Unlike simple back pain or sciatica, cervical myelopathy typically requires surgery.

Why? Because the natural history of myelopathy is step-wise deterioration. You might be stable for a while, then suddenly get worse after a minor fall or neck jerk. Once the spinal cord is damaged, it has very limited ability to repair itself.

The Goal of Surgery: Stop the progression. We perform surgery to prevent you from getting worse. Any recovery of lost function is a bonus, not a guarantee.

Surgical Procedures We Perform

We choose the approach based on where the compression is coming from (front or back):

• ACDF (Anterior Cervical Discectomy and Fusion):
  • Approach: From the front of the neck (a small skin crease incision).
  • Procedure: We remove the bad disc or bone spur pressing on the cord and place a cage/spacer to fuse the bones.
  • Recovery: Patients usually go home the next day.
• Cervical Laminectomy (with or without Fusion):
  • Approach: From the back of the neck.
  • Procedure: We remove the lamina (the roof of the spinal canal) to give the spinal cord more room to drift back away from the compression.
  • Best For: Patients with compression at multiple levels (e.g., C3 to C7).
• Cervical Disc Replacement:
  • Best For: Younger patients with soft disc herniations who want to preserve neck motion.

Recovery Expectations: What Happens After Surgery?

Recovery from myelopathy surgery is a journey.

Immediate Post-Op (Weeks 1-2)

• Pain Relief: Arm pain often resolves immediately.
• Walking: You will be walking the same day of surgery.
• Safety: You may need to wear a soft collar for comfort for 2 weeks.

Neurological Recovery (Months 3-18)

• The "Numbness" Factor: Numbness and balance issues take the longest to improve. Nerves heal very slowly (about 1mm per day).
• Physiotherapy: Essential for retraining your gait and fine motor skills.
• Plateau: Most recovery happens in the first 6-12 months.

Conclusion

Your spinal cord is the highway of your nervous system. Traffic jams here can shut down everything below—your hands, your legs, your bowel control. If you recognize these signs in yourself or an elderly parent (spondylosis is a common cause), don't dismiss it as "just aging."

Early diagnosis saves function. If you can walk into the clinic, we want to keep you walking. Waiting until you need a wheelchair makes recovery significantly harder.

Concerned about clumsiness or balance issues? Book a consultation or get a second opinion from Dr. Sayuj Krishnan for a thorough neurological evaluation.