Early identification of cervical myelopathy through MSK assessment
The Challenge
A 43-year-old active patient presented with a 12-month history of worsening knee discomfort and expected referral for knee MRI.
Initial symptoms included:
- Anterolateral knee pain
- Morning stiffness
- Mild tingling
- Intermittent pseudo-locking
There were no obvious spinal or inflammatory features.
Our Clinical Approach
While musculoskeletal examination was unremarkable, detailed neurological assessment identified:
- Brisk reflexes
- Left-sided clonus
- Positive Babinski response
- Bilateral Hoffmann’s sign
- Mild weakness and gait change
Recognising clear upper motor neurone signs, the clinician escalated immediately for urgent neurology review.
The Outcome
MRI confirmed:
- Compressive cervical myelopathy
- C1/C2 instability
- Significant spinal cord compression
The patient underwent urgent neurosurgical fixation.
Early intervention prevented further neurological deterioration and enabled appropriate rehabilitation.
Why This Matters
This case demonstrates:
- The importance of full neurological assessment
- Recognition of non-MSK pathology presenting as joint pain
- Safe escalation based on clinical reasoning
- The wider system value of experienced MSK clinicians in primary care
