ASIA Flashcards
C5 muscles
elbow flexors - biceps, brachialis
C6 muscles
wrist extensors - ECRL and ECRB
C7 muscles
elbow extensors - triceps
C8 muscles
long finger flexors - FDP
T1 muscles
small finger abductor - abductor digiti minimi
L2 muscles
hip flexors - iliopsoas
L3 muscles
knee extensors - quads
L4 muscles
ankle dorsiflexors - tibialis anterior
L5 muscles
long toe extensors - extensor hallucis longus
S1 muscles
ankle plantarflexors - gastroc, soleus
ASIA A
complete: no motor or sensory function preserved in sacral segements
ASIA B
incomplete: sensory but no motor function preserved below neurologic funciton
ASIA C
incomplete: motor function preserved below the neurologic level (> 1/2 of muscles have a muscle grade <3)
ASIA D
incomplete: motor function preserved below the neurologic level (1/2 of muscles have a muscle grade>/= 3)
ASIA E
normal: sensory and motor function normal
motor score meanings 0-5
0 - total paralysis
1 - palpable or visible contraction
2 - active movement, gravity eliminated
3 - active movement, against gravity
4 - active movement, against some resistance
5 - active movement, against full resistance
NT - not testable
sensory scoring 0-2
0=absent
1=altered
2= normal
voluntary anal contraction and deep anal pressure are both absent what is the asia
ASIA A (NOON sign)
when to test non-key muscles
in a patient with an apparent AIS B classification, non-key muscle functions more than 3 levels below the motor level on each side should be tested to most accurately classify the injury (differentiate between ASIA B and C)
typical presentation C4
muscles available: diaphragm, trapz. levator scap, rhomboids
available mvmts: BREATH INDEPENDENT of VENT
scapular elevation
typical presentation C5
muscles available: deltoid, biceps, brachialis, brachioradialis, infraspinatuss/teres minor, supinator
movements available: elbow flexion, forearm supination, shoulder ER and ABD
operate power wc w joysyick
typical presentation C6
muscles availableL: pec, serratus, lats, ECR, pronator teres
movement available: wrist ext, forearm pronation, shoulder scap stability/strength
significantly > functional potential than above levels
typical presentation C7
muscles available: pec major, TRICEPS, FCR, EPL/B, extrinsic finger extensors
movements available: elbow ext, wrist flexion, finger ext
potential for independent function
typical presentation C8-T1
muscles available: extrincis finger flexors, FCU, FPL/B, intrinsic finger flexors
movements available: fine motor skills
typical presentation T2-T6
muscles available: full UE, partial intercostals, partial back extensors
function: independent all mobiltiy and ADLS at manual wc level
typical presentation T7-L1
muscles available: full UE, intercostals partial/full, abs & back ext(extent depend on level)
function: improved effective cough, independent all mobility and ADLs at manual wc level
typical presentation L2-L5
muscles available:
L2- hip flexors, ADDs
L3 - knee ext
L4 - ankle DF
L5 - hip ABD, knee flexion, ankle
ambulation becomes feasblie goal w AD and LE bracing
typical presentaation S1-S2
S1 - knee flexion, hip ext, ankle PF/inv/ever
S2 - hip ext, rotation and full anlke
community ambulation wit minimal to no bracing or AD
types of incomplete SCI syndromes
anterior cord
central cord
posterior cord
brown-sequard
conus medullaris
cauda equina
anterior cord syndrome
Loss of movement, pain, and temp. Still able to feel position, vibration and touch.
Etiology-
Lesions of anterior spinal artery
Presentation:
Loss of motor
Loss of pain & temperature
Relative preservation of position sense & vibration
Prognosis:
Generally poor (10-20%) for motor recovery
central cord syndrome
loss of movement and sensation. complete loss below level of injury?
When process of central hemmorhage/necrosis due to tissue damage does not progress to full destruction of cord segmentperipherally located fiber tracts intact
Spatial orientation of tracts – cervical segments located closer to central gray matterT, L, S segments located progressively more peripherally in cord.
Etiology:
Most common in older people following extension injuries
Damage to central aspect of cord, sparing peripheral aspects
Presentation:
Motor & sensory loss in UEs
Trunk & LEs may be affected dependent on severity
Prognosis:
> 50 y.o. only 41% (I) community ambulators
< 50 y.o., 97% (I) community amb
Brown Squared syndrome
loss of pain, temperature, and light touch of opposite side. Loss of motor function and vibration, position, and deep touch sensation on same side
Etiology:
damage to ½ of the cord (hemi-section)
Most common cause = stab/gunshot wound
Presentation:
Ipsilateral side
motor loss
sensory loss of proprioception, vibration
Contralateral side
sensory loss of pain & temp
Prognosis:
Good for recovery – most will regain bladder/bowel function; most will become ambulatory
Conus Medullaris
Terminal segment of spinal cord at bony level of L1
Affects S2 to S4-5
UMN lesion (likely LMN component)
Bowel and bladder dysfunction
Sexual dysfunction
LE strength may remain intact
Saddle anesthesia
Often combination of UMN and LMN – conus and cauda
Urinary and fecal incontinenceTypically symmetric presentation: Distal paresis of lower limbs is less marked
Cauda Equina
Lesion below L1
LMN deficits
LE motor weakness & atrophy (L2-S2)
Areflexia/hypotonia
Bowel & bladder involvement
Pain
May have spared perineum sensation - sometimes
Common Causes:Traumatic injury
Disk herniationSpinal stenosis
Spinal tumors (neoplasms): metastatic tumors, meningiomas, schwannomas, and ependymomas
Inflammatory conditionsInfectious conditionsAccidental causes by medical intervention
