Apparent C8-T1 radiculopathy with hand weakness due to mid-cervical spondylosis

Hand weakness and wasting in the setting of mid-cervical spondylosis and disc herniation without radiological evidence for compression of the C8 or T1 roots has been rarely reported. We retrospectively studied the data of patients with hand weakness and mid-cervical spondylosis. The clinical and radiological findings were compared to a control group of patients with weakness of the arm or forearm muscles and similar mid-cervical spondylosis. We found 19 patients with weakness and atrophy of the intrinsic hand muscles, and 13 patients with weakness proximal to the hand muscles to serve as a control group. Eleven patients (58%) had lower limb hyperreflexia or Babinski sign. Nine patients (47%) had compression of the C7 root, 12 patients (63%) had compression of C6, 8 patients (42%) had compression of C5, and 2 patients (11%) had compression of the root C4. In all but three patients (84%), magnetic resonance imaging (MRI) showed cord compression. In the control group, five patients (38%) showed hyperreflexia of the lower limbs and Babinski sign. Five patients (38%) had compression of the C7 root, eight patients (62%) had compression of C6, and twelve patients (92%) had compression of C5. Cord compression was found in eight patients (62%). Hand muscle weakness and wasting due to mid-cervical spondylosis seems to be more common than usually believed. The lack of clinical-radiological correlation should not mislead the clinician from the correct diagnosis, and should not delay the surgical decompression of the cord and the roots.