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Question 1

Motor Exam Strengths

Answer 1

0: flaccid
1: twitch
2: full range with gravity eliminated
3: full range against gravity
4: gives way against resistance
5: full and normal strength

Question 2

Motor Evaluation

Answer 2

C4: intact diaphragmatic breathing
C5: deltoid Function/biceps
C6: ECRL/ECRB 
C7: triceps/FCR
C8: FDS/FDP

T1: Interossei

L1-2: Iliopsoas
L3-4: Quad
L4: tibialis anterior
L5: hip abductor, extensor Hallucis longus, peroneals

S1: hamstrings, gastrocnemius, flexor Hallucis longus

Question 3

Cervical Spondylosis

Answer 3

Degeneration of the cervical spine that is progressive with age, spine arthritis

Neck pain, radicular pain in arm, myelopathy

90% in males over 50 or females over 60

Question 4

Cervical Spondylotic Radiculopathy

Answer 4

Insidious onset with a hard disc if older than 50, sudden and traumatic with soft disc if under 40

Pain, paresthesis, referable to individual nerve root

Surgical indications: progressive neurologic deficit, conservative treatment of 1.5-3 months fails

Question 5

Cervical Spondylotic Myelopathy

Answer 5

Burning sensation, loss of hand dexterity, imbalance

Surgical Indications: severe disability with poor improvement rates and benefit from decompression

Question 6

Low Back Pain

Answer 6

1. Radiographs: weight bearing and dynamic flexion/extension parts of spine

Older than 50, symptoms longer than a month, direct trauma, history of neoplasm

2. MRI: weakness, bowel or bladder symptoms, failure of conservative treatment for 4-6 weeks

Causes: myofascial strain, facet atrophy, disk herniation, stenosis, deformity like scoliosis, fracture, infection/neoplasm, hip/abdominal pathology

Red flags: constitutional symptoms like fever or weight loss, constant axial pain, cauda equina Syndrome with bladder or bowel dysfunction, progressive neurologic loss

Question 7

Lumbar Disc Herniation

Answer 7

Lumbar herniations don’t affect their respective exiting nerve root but rather the transversing nerve root

Herniation between L4 and L5 affects L5 nerve, if cervical herniations than affect the nerve of the uppermost vertebrae

Treatment: controlled physical activity, NSAIDS, epidural steroids

Surgery indications: cauda equina Syndrome, progressive neurologic deficit, failure of conservative treatment for 1.5-3 months

Question 8

Lumbar Spinal Stenosis Basic Anatomy

Answer 8

Narrowing of the spinal cord

Lateral canal stenosis from hypertrophy of superior articular facet
Lateral recess (sub articular area or entrance zone), foraminal zone (mid zone), extraforaminal (exit zone)

Central canal stenosis from inferior articular facet hypertrophy, disc bulging, or ligamentum flavum hypertrophy
40% due to soft tissue hypertrophy

Progressive degeneration: intervertebral discs, facet joints, ligamentum flavum

Question 9

Spinal Cord Stenosis Clinical Applications

Answer 9

1. Clinical Presentation: neurogenic claudication (lower leg pain), radiculopathy, low back mechanical pain, cauda equina syndrome

Females more than guys, 50-80 y.o., pain in lower back and butt/calf

Single or multiple nerve roots, bilateral, from L3-4 or L4-5, small percent Associated with cervical stenosis

Neurogenic claudication: LE fatigue, symptoms relieved by rest, walking restricted over time, neurogenic bladder if severe

Easier when trunk is flexed like with grocery cart or walking uphill, have pain walking downhill when extended