This 45 year old lady presents to her family physican with a 6 month history of progressive numbness to her thumb and index finger of her right hand. She has noted some clumsiness of her hand and difficulty with strength of grip when opening jars.

She had also noted a band of numbness over her chest wall bilaterally.

She denied any bowel or bladder dysfunction, but had noted some stiffness of her legs with difficulties with spasms of her legs especially at night.

Her past history was unremarkable except that 5 years ago, she was involved in a motor vehicle accident in which she had suffered a fracture of her C6 vertebral body which was not displaced and treated conservatively with a hard collar for 3 months.