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학습 자료 둘러보기 →In a patient with long-standing rheumatoid arthritis, any new onset of paresthesia or motor weakness in the extremities must be treated as a cervical myelopathy until proven otherwise. The most common cause is atlantoaxial subluxation from ligamentous erosion.
Immediately place the patient in a rigid cervical collar and maintain strict spinal precautions. Notify the provider urgently and prepare for emergent MRI of the cervical spine. Do not perform a range of motion assessment, as manipulation can worsen cord compression.
Do not mistake these findings for a peripheral neuropathy or carpal tunnel syndrome. The presence of decreased grip strength alongside sensory changes points to an upper motor neuron lesion from cord compression, which can rapidly progress to irreversible paralysis or respiratory failure.
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