A 75-year-old man developed progressive right-hand weakness over 3 years. Examination revealed myelopathic hand, inverted radial reflex, and Wartenberg thumb reflex (Video 1). MRI demonstrated cervical spondylotic myelopathy (Figure). Surgical decompression stabilized symptoms.
Video 1
Inverted radial reflex: when tapping the radius, there is absent brachioradialis contraction and hyperactive finger flexion. Wartenberg thumb reflex: when the affected hand applies forceful flexion at the terminal phalanges, there is adduction, flexion, and opposition of the thumb; a normal response maintains abduction and extension of the thumb.Download Supplementary Video 1 via http://dx.doi.org/10.1212/013262_Video_1
Inverted radial (supinator) reflex is a myelopathic sign localizing to C5-6.1 Interruption of C5-6 roots and pathologic spread to C8 roots lead to absent brachioradialis contraction with finger flexion.1 Wartenberg thumb reflex (distinct from unrelated Wartenberg2 sign in ulnar neuropathy) is an early sign that may precede pyramidal weakness—when the affected hand applies forceful flexion at the terminal phalanges there is adduction, flexion and opposition of the thumb.
Study Funding
The author reports no targeted funding.
Disclosure
T. Chen reports no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Acknowledgment
The author thanks the patient for permission to publish this video.
Appendix Author
Footnotes
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Teaching slides links.lww.com/WNL/B732
- © 2021 American Academy of Neurology
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