Frequency of Classical Hand Signs in Cervical Spondylotic Myelopathy: A Prospective Cross-Sectional Observational Study.

Background Cervical spondylotic myelopathy (CSM) is a predominant cause of progressive neurological disability in ageing populations, frequently manifesting initially as subtle hand dysfunction before gait abnormalities. Early recognition is essential to prevent irreversible corticospinal damage. Although MRI remains the standard for anatomical assessment, bedside neurological evaluation combined with quantitative hand function testing may detect early functional compromise. This study aimed to determine the frequency of classical hand signs, quantify grip strength impairment, and correlate and evaluate their association with validated functional severity scales. Methods and materials This prospective cross-sectional observational study included 102 consecutive adults with clinically suspected and MRI-confirmed cervical spondylotic myelopathy treated at a tertiary spine center between August 2024 and January 2025. Demographic details, symptom profile, and neurological findings were recorded. Classical hand signs, including Hoffmann's sign, finger escape sign, grip-and-release test, crossed radial reflex, and inverted radial reflex, were systematically assessed. Grip strength was objectively measured using a calibrated hand dynamometer. Functional severity was graded using the modified Japanese Orthopaedic Association (mJOA) score and Nurick's scale. Magnetic resonance imaging (MRI) was used to confirm the diagnosis. Categorical variables were summarized using frequencies and percentages. Associations between clinical hand signs and functional severity scores were assessed using Pearson correlation analysis, with statistical significance set at p < 0.05.  Results A total of 102 patients were included, predominantly elderly, with 79/102 (77.5%) aged ≥60 years and a male preponderance of 78/102 (76.5%). Gait imbalance was the most common presenting symptom, reported in 75/102 (73.5%), followed by impaired hand dexterity in 58/102 (56.9%). At least one classical hand sign was present in 73/102 (71.6%) patients. Hoffmann's sign was positive in 49/102 (48.0%), the finger escape sign in 44/102 (43.1%), and the grip-and-release test in 17/102 (16.7%). Most patients demonstrated moderate functional impairment, with the highest frequency of mJOA scores between 10-12 (42/102, 41.2%) and Nurick's grades 3-4 (56/102, 54.9%). Hand signs showed significant correlation with disease severity, demonstrating a negative correlation with mJOA score (r = -0.40, p < 0.001) and a positive correlation with Nurick's grade (r = 0.433, p < 0.001). Conclusions Classical hand signs and grip impairment were frequently observed in cervical spondylotic myelopathy and showed a significant association with functional severity scores (mJOA and Nurick). Structured bedside neurological examination may serve as a practical adjunct to imaging in assessing disease severity.