A 62-year-old woman comes to the office due to progressive gai | Surgery collections Videos and quizez 2021

A 62-year-old woman comes to the office due to progressive gait unsteadiness. The patient's legs feel stiff, and she frequently stumbles and has to hold handrails while descending stairs. She also has had tingling and numbness in the hands and an occasional electric shock-like sensation in the spine. She has had no bowel or bladder incontinence. The patient has fibromyalgia and continues to have shoulder and neck pain despite a recent dosage increase in duloxetine. Other medical conditions include depression and hypothvroidism. She does not use tobacco, alcohol, or illicit drugs. Examination of the cranial nerves is normal. Upper extremity muscle strength is decreased, with mild wasting of intrinsic hand muscles. Lower extremity tone and reflexes are increased bilaterally. Sensation is grossly intact