The characteristic syndrome consists of combinations of the following in varying degrees: (1) painful, stiff neck or pain in the neck, shoulders, and upper arms (brachialgia) that may be aching or radicular (stabs of sharp and radiating pain evoked by movement), asymmetric or unilateral; (2) numbness and paresthesias of the hands; and (3) spastic leg weakness with Babinski signs, unsteadiness of gait, and a Romberg sign. The numbness and paresthesias are occasionally the earliest symptoms and typically involve the distal limbs, especially the hands. Variations of these symptoms are elaborated below. Each of the components may occur separately, or they may occur in combination, particularly myelopathy with radiculopathy.
With reference to the most common of these symptoms, the neck and shoulder pain, in any sizable group of patients older than 50 years of age, approximately 40 percent will be found at times to have some clinical abnormality of the neck, usually crepitus or pain, with restriction of lateral flexion and rotation (less often of extension). Pallis and colleagues, in a survey of 50 patients, all of them older than 50 years of age and none with neurologic complaints, found that 75 percent showed radiologic evidence of narrowing of the cervical spinal canal as a result of osteophytosis of the posterior vertebral bodies or of narrowing of the intervertebral foramina because of osteoarthropathy at the apophyseal joints; thickening of the ligaments (both the ligamentum flavum posteriorly and the posterior longitudinal ligament anteriorly) adds to the narrowing of the canal. However, only half of the patients with radiologic abnormalities showed physical signs of root or cord involvement such as changes in the tendon reflexes in the arms, briskness of reflexes and impairment of vibratory sense in the legs, and sometimes Babinski signs. The occasional finding of a Babinski sign in older individuals who had never had a stroke or complained of neurologic symptoms is often explained by an otherwise inevident cervical osteophyte (Savitsky and Madonick).
The pain is usually centered at the base of the neck or higher, often radiating to an area above the scapula. When brachialgia is also present, it takes several forms: a sharp pain in the preor postaxial border of the limb, extending to the elbow, wrist, or fingers; or a persistent dull ache in the forearm or wrist, sometimes with a burning sensation. Discomfort may be elicited by coughing, Valsalva maneuver, or neck extension, or neck flexion may induce electrical feelings down the spine (Lhermitte symptom). Rarely, the pain is referred substernally.