What finding would indicate possible cervical myelopathy during examination?

• A. Positive shoulder shrug test
• B. Positive Babinski reflex
• C. Unilateral arm weakness
• D. Pain with cervical rotation

Answer: (B)

The presence of a positive Babinski reflex is indicative of potential cervical myelopathy. Cervical myelopathy arises from spinal cord compression due to various factors, such as degenerative changes or trauma. When the spinal cord is affected, it can lead to upper motor neuron signs, which include the positive Babinski reflex. This reflex normally involves the extension of the big toe when the sole of the foot is stroked, rather than a flexion response. The emergence of this reflex in adults points to an issue with the neurological pathways that control voluntary movement, aligning with the symptoms of cervical myelopathy.

In contrast, while the shoulder shrug test may provide information about upper trapezius strength or accessory nerve function, it does not specifically indicate myelopathy. Similarly, unilateral arm weakness suggests a more localized neural issue or peripheral nerve injury, rather than a systemic problem like cervical myelopathy. Lastly, pain with cervical rotation could be indicative of various cervical spine disorders, but it is not a definitive sign of myelopathy, which is characterized more by neurological deficits than localized pain. Thus, the positive Babinski reflex is the most specific finding associated with cervical myelopathy.