Hirayama disease is characterized by progressive muscle wasting and weakness of the distal upper limb especially small muscles of hand(s) predominantly in young males, followed by spontaneous arrest within several years. It was thought to be due to short dura (compared to bony vertebrae), which detaches from its posterior attachment and compresses the cord during every neck flexion leading to minor ischemic damage to anterior horn cells. During progressive stage of the disease application of a cervical collar to restrict neck flexion may minimize the ischemic insult and arrest progression of the disease. Four young male patients presented with painless unilateral wasting and weakness of hand and forearm without involvement of other limbs. MRI shows focal atrophy of cervical cord and extended flexion study reveals detached posterior dura compressing the cord with an enhancing posterior epidural mass confirming the diagnosis of Hirayama's disease. Nerve conduction studies shows predominant ulnar motor involvement compared to median nerve and electromyography showing denervation of lower cervical segment supplementing the diagnosis. Cervical collar is given to arrest the progression if there is any.