skip to main content

Degenerative cervical myelopathy — MSRA MCQ

Instant feedback + full explanation. One question, done properly.

ModerateMRIDegenerative cervical myelopathyMSRA

A 55-year-old man presents with 7 weeks of right-sided neck pain radiating to the thumb and index finger, with paraesthesia in the same distribution. During the last 10 days, he has also noticed increasing difficulty fastening shirt buttons and has stumbled twice when turning quickly. There is no trauma, fever, weight loss, history of malignancy, or bladder or bowel disturbance. Examination shows reduced fine finger movements in the right hand, brisk triceps reflexes bilaterally, brisk knee reflexes, and a positive Hoffmann sign. Power is 5/5 throughout. He has no contraindication to MRI. What is the most appropriate next management plan?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Arrange urgent spinal or neurosurgical assessment for suspected cervical myelopathy, with cervical MRI through the urgent pathway

Explanation lettering: D = shown as A · C = shown as B · E = shown as C · B = shown as D · A = shown as E

This presentation has evolved beyond uncomplicated cervical radiculopathy. The radicular arm pain and thumb/index-finger paraesthesia suggest a cervical root syndrome, but new hand clumsiness, gait disturbance and upper motor neurone signs (brisk reflexes and Hoffmann sign) indicate possible cervical cord involvement: degenerative cervical myelopathy. This requires urgent specialist spinal or neurosurgical assessment, with MRI used to define cord compression and guide management. A is inappropriate because conservative management is reasonable for stable radiculopathy without myelopathic features, but risks delay where cord dysfunction is suspected. B underestimates the urgency: routine MSK triage is unsuitable when there are clinical signs of myelopathy. D may appear efficient, but imaging should not delay urgent specialist assessment; MRI interpretation must be integrated with the clinical severity and potential need for decompression. E is not indicated because there are no features suggesting malignancy, such as cancer history, constitutional symptoms or persistent non-mechanical pain. NICE specifically identifies clumsy or weak hands, gait disturbance and brisk reflexes as features in cervical radiculopathy that should prompt referral rather than routine conservative management.

Reference: NICE NG127: Suspected neurological conditions: recognition and referral — recommendations for adults aged over 16, section 1.10.11 (Last updated 2 October 2023) — https://www.nice.org.uk/guidance/ng127/chapter/recommendations-for-adults-aged-over-16 NHS Greater Glasgow and Clyde Right Decisions: MSK Physiotherapy Service referral guidance (Last reviewed 31 January 2024) — https://www.rightdecisions.scot.nhs.uk/ggc-primary-care/musculoskeletal-system/musculoskeletal-referral-guidance/msk-physiotherapy-service/