Degenerative cervical myelopathy (DCM) is a clinical syndrome characterized by a progressive compression of the spinal cord. DCM often looks like common symptoms of aging or bilateral carpal tunnel syndrome in its early stages, requiring careful differential diagnosis. Identifying DCM is a real challenge as no validated screening tools are available for making the DCM diagnosis. Potentially, individuals with DCM may experience misdiagnosis or substantial diagnostic delays, with an enhanced risk of irreversible neurological consequences if not promptly addressed. Despite the increasing prevalence, there is a lack of awareness about DCM among both the public and healthcare professionals. However, patients may seek physiotherapy to obtain a diagnosis or access treatment. A comprehensive (non-systematic) review of the literature about DCM epidemiology, pathophysiology, clinical presentation, diagnostic methods, and management was conducted. A guide and essential knowledge to facilitate clinicians to understand DCM and to enhance clinical reasoning skills, performance and interpretation of the examination are provided. Interdisciplinary collaboration and optimal referral methods are also handled. The aim of this article is to summarize and enhance physiotherapists' essential knowledge of the differential diagnosis and management of patients with DCM.

Evidence on degenerative cervical myelopathy (DCM) has frequently focussed on surgical management, overlooking the role of non-surgical clinicians. Their contributions in the patient journey remain largely underexplored in the literature. What is the role of non-surgical clinicians in the assessment and management of people with DCM? This narrative review synthesizes knowledge from a comprehensive MEDLINE search and the collective expertise of the RECODE-DCM Peri-Operative Rehabilitation Incubator, an expert working group hosted by Myelopathy.org. Key domains of non-surgical clinician involvement include: 1) early recognition and referral, 2) patient education, 3) pain management, 4) preoperative management, and 5) postoperative rehabilitation. Timely DCM diagnosis depends on first-contact clinicians recognizing hallmark symptoms. In the absence of standardized screening criteria, tools like the modified Japanese Orthopaedic Association score can support early identification. Non-surgical clinicians educate patients with mild or non-myelopathic spinal cord compression to recognize signs of DCM progression, ensuring timely surgical consultation. These clinicians also play a multidisciplinary role in the biopsychosocial management of pain, incorporating pharmacological and non-pharmacological strategies to address nociceptive and neuropathic pain. While predictors of postoperative outcomes, such as disease severity, gait dysfunction and smoking, are known, evidence on preoperative optimization and prehabilitation remains limited. Emerging research highlights the benefits of early postoperative rehabilitation, including cervical range of motion and stabilization exercises, in improving 12-month postoperative outcomes. Non-surgical clinicians play an integral role in DCM management across the care continuum. A multidisciplinary, patient-centred approach is essential. Postoperative rehabilitation holds promise, but prospective trials are necessary to establish standardization and optimal strategies for clinical delivery.

Introduction: Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Adequate condition awareness and the ability to recognise key clinical signs are crucial for timely referral and diagnostic imaging. However, the level of awareness and diagnostic confidence among New Zealand primary care clinicians remains unclear. Aim: This study aimed to evaluate self-reported condition awareness, diagnostic confidence, and understanding of DCM signs, symptoms, and management pathways among New Zealand primary care clinicians. Methods: A cross-sectional survey with two sections was developed, piloted, and distributed through professional associations. Participants included general practitioners, nurse practitioners, physiotherapists, osteopaths, and chiropractors. Section A (demographics, DCM education, and ratings of awareness and confidence) was completed by all respondents. Section B (knowledge-based items) was completed by respondents who reported being at least ‘slightly’ confident. Results: The survey yielded 336 responses, of which there were 320 complete responses for Section A and 227 complete responses for Section B. Over half (57.2%) of respondents reported no prior DCM education, and 43.1 and 32.5% reported ‘average’ or ‘limited’ awareness respectively. Low diagnostic confidence was reported by 25.9 (slightly confident) and 22.2% (not at all confident). Symptoms such as upper limb paraesthesia/numbness and neck pain/stiffness were selected by 98 and 95% of respondents as being associated with DCM. The most recognised clinical sign, tandem gait disturbance, was noted by only 65%. Magnetic resonance imaging was identified as the key diagnostic investigation by 73.6%, and 64.8% selected referral to an orthopaedic surgeon, spine surgeon, or neurosurgeon. Discussion: These findings reveal critical gaps in DCM awareness, diagnostic confidence, and knowledge among New Zealand primary care clinicians. It is possible that these gaps contribute to missed and delayed diagnosis for people living with DCM, who subsequently face irreversible neurological compromise resulting from delayed intervention. This study suggests that there is a need for improved education of primary healthcare professionals in regard to this condition and the development of standardised diagnostic criteria.

Introduction/Aims: Diagnosis of degenerative cervical myelopathy ( DCM ) is frequently delayed. A lack of awareness and standardized screening criteria have been identified as major contributors. The objective of this study was to conduct a survey of international experts to determine the value of various signs and symptoms in diagnosing patients with DCM . This study forms part of a three‐step initiative that aims to develop pragmatic screening criteria for DCM . Methods: An open voluntary English‐language Likert scale survey was disseminated among international networks of experts in DCM . Respondents were asked to rank each sign or symptom on a scale of 0 ( not important at all ) to 10 ( extremely important ); a mean value of ≥ 6.5 was set a priori as the threshold to consider a feature as having significant diagnostic value. Results: Fifteen symptoms and 12 signs were ranked as having significant diagnostic value. The most highly ranked symptoms are primarily related to abnormalities of the upper limb, hand function, and gait. The top‐rated signs included pathological reflexes as well as impairment of motor function, gait, and coordination. Features ranked as significant were largely consistent across professions, levels of experience, and continental regions. Discussion: The integration of expert stakeholder opinion with evidence from existing literature strengthens the clinical framework for identifying key clinical features of DCM . These 27 features will be discussed at an international consensus meeting to establish a standardized clinical screening toolkit that can be used by frontline healthcare professionals to detect patients with DCM .

Physical therapists (PTs) working in primary care settings commonly encounter mechanical causes of knee pain. Non-mechanical causes of knee pain, such as bone tumors, are rare, and therefore, PTs often have a low index of suspicion regarding sinister pathology. The purpose of this case report is to describe the physical therapist’s clinical reasoning process for a 33-year-old female presenting with medial knee pain and a subsequent history of metastatic melanoma. Initially, subjective and objective testing pointed to a mechanical internal derangement of the knee. However, symptom progression and poor treatment responses between physical therapy visits 2 and 3 raised suspicions as to the cause of the knee pain. This prompted an orthopedic referral and medical imaging, revealing a large bone tumor invading the medial femoral condyle, which was further characterized as metastatic melanoma by a specialty oncology team. Further imaging revealed several metastatic subcutaneous, intramuscular and cerebral lesions. This case highlights the importance of the ongoing medical screening process, including the monitoring of symptoms and treatment responses.

Introduction Outcomes for degenerative cervical myelopathy (DCM) patients are limited by delayed and missed diagnoses, driven in part by poor professional awareness. Despite DCM being the most common cause of adult spinal cord injury, it remains under-recognised and undertaught in clinical education. Lessons from other common pathology like stroke and acute myocardial infarction highlight the potential of education to improve early diagnosis. This study will develop a professional education strategy to improve early DCM diagnosis. It will define key audiences and identify an effective delivery method, laying the groundwork for a sustained, targeted intervention. Methods and analysis The study aims to define who needs to know about DCM, what they need to know and how they can learn it. This will be carried out in three phases: phase 1—who and what: to establish the target population and to define core competencies for the educational intervention; phase 2—how: to create and review the educational intervention; phase 3—evaluation: to test whether the framework is an improvement to existing strategies. Ethics and dissemination Ethical approval is in place from the University of Cambridge (HBREC.2024.24). Results from the study will be disseminated through scientific publication, conference presentation, blog posts and podcasts. PROSPERO registration number CRD42023461838