L’hermitte’s Sign

Many people experience neck pain nowadays. Cervical myelopathy is a form of myelopathy that involves compression of the spinal cord in the cervical spine (neck). The cervical spine contains seven vertebrae (C1 to C7), with six intervertebral discs and eight nerve roots. The spinal cord travels inside the vertebral column constructed from the front by vertebrae, cushioned by the intervertebral discs and from the back by the facet joints and lamina. In the cervical spine, eight nerve roots branch out that primarily control the function of shoulders, arms and hands.

If neck flexion causing electric shock type sensation and also radiates into the upper and lower extremities than we can admire this symptom as L’hermitte’s sign.

Symptoms:

Cervical myelopathy produces two types of symptoms: the ones you may feel in the neck, and the ones appearing elsewhere in the body at or below the compressed area of the spinal cord.

The neck symptoms may include:

Neck pain
Stiffness
Reduced range of motion

As the disease progresses, one may experience shooting pain that originates in the neck and travels down the spine.

Other cervical myelopathy symptoms may include:

Weakness in the arms and hands
Numbness or tingling in the arms and hands
Clumsiness and poor coordination of the hands
Difficulty handling small objects, like pens or coins
Balance issues

Investigation:

X-ray: X-ray shows the images of internal tissues, bones and organs onto film.
Magnetic resonance imaging (MRI): MRI shows detailed images of organs and soft tissue structures in body.
Computed tomography (CT) scan. X-rays and computer technology make horizontal or axial images of body. A CT scan shows detailed images of any part of body including bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

Treatment

Acute phase: In an acute condition patient needs to take rest and icing the area 10-15 minutes for two times a daily. Patient can also use cervical (neck) collar to give neck muscle rest or time for healing process.

Chronic phase: In most cases it will take 14 days to 1 month to heal but if the case is in chronic condition than it can take up to six months to heal.

In chronic condition patient must concern with a physiotherapist for better solution. A physiotherapist will apply two types of treatments. They are:

Manual:
Activity modification: A physiotherapist will find out the improper techniques for which he/she suffers with the condition. Also the physiotherapist will correct his/her functional techniques.
Range of motion improving exercises: After checking ROM of the affected region physiotherapist will improve the condition of restricted motion. In this stage physiotherapist can apply some stretching exercises.

Strengthening exercises: To improve muscle endurance and capacity patient have to continue strengthening exercises.
Mobilization: Cervical mobilization plays an important role in cervical myelopathy.
Distraction: It may plays on lying and sitting both positions. If patient feels comfort than it is quite better to do distraction manually on lying position. The physiotherapist will place his/her one hand below the neck and the other will cover the chin area and patient’s head should place outer from bed.