Clinical Assessment of Spinal Cord

Question 1

extramedullary

Answer 1

• lesions that arise outside of spinal cord; tend to cause early pain and UMN signs, and pain/temp sensation likely to evolve in ascending fashion (sacral, then lumbar, then thoracic, cervical progressively)

Question 2

Intramedullary lesions

Answer 2

• arise within cord
• tend to cause early bladder dysfunction with only late development of pain
• loss of pain/temp may progress in descending fashion (cervical to sacral)

Question 3

C5 dermatome

Answer 3

typically back of shoulder/lateral arm

Question 4

C6 dermatome

Answer 4

typically covers thumb, usually second digit too

Question 5

C7 dermatome

Answer 5

usually covers third digit (middle finger)

Question 6

T4 dermatome

Answer 6

nipple line

Question 7

T6 dermatome

Answer 7

xyphoid process

Question 8

T10 dermatome

Answer 8

umbilicus

Question 9

L4 dermatome

Answer 9

kneecap, medial leg

Question 10

L5 dermatome

Answer 10

dorsum of foot, great toe

Question 11

S1 dermatome

Answer 11

lateral foot, small toe, sole of foot

Question 12

purpose of observation and inspection of muscles

Answer 12

identify atrophy, hypertrophy, fasciculations, tremor, other involuntary movements

Question 13

spasticity

Answer 13

velocity-dependent increase in muscle tone

Question 14

Technique to test DCML

Answer 14

light touch- cotton/gauze
vibration sense - tuning fork
joint position sense
2 point discrimination (bent paper clip)

Question 15

technique to test pain and temperature sensation

Answer 15

pain - safety pin

temperature - cold tuning fork

Question 16

Scale for testing reflexes

Answer 16

0- no reflex
1+ trace
2+ normal
3+ brisk
4+ nonsustained clonus (repetitive vibratory movements)
5+ sustained clonus

Plantar reflex described as flexor, extensor (babinski sign), or ambivalent

Question 17

C5 motor function

Answer 17

deltoid, infraspinatus, biceps

Question 18

C5 sensory

Answer 18

shoulder, upper lateral arm

Question 19

C5 reflex

Answer 19

biceps

Question 20

usual disc involved in C6 injury

Answer 20

C4-5

Question 21

appx % radiculopathies

Answer 21

10% of upper extremity

Question 22

C6 motor function

Answer 22

wrist extens, biceps

Question 23

C6 sensory

Answer 23

1/2 digits of hand

Question 24

C6 reflex

Answer 24

biceps, brachioradialis

Question 25

C6 injury disc usually involved

Answer 25

C5-6

Question 26

~% of radiculopathies involving C6

Answer 26

20% of upper extremity

Question 27

C7 motor function

Answer 27

triceps

Question 28

C7 sensory

Answer 28

3rd digit

Question 29

C7 reflex

Answer 29

triceps

Question 30

C7 usual disc involved

Answer 30

C6-7

Question 31

% radiculopathies involving C7

Answer 31

40-50% upper extremity

Question 32

L4 motor, sensory, reflex

Answer 32

M: psoas, quads
Sensory: knee, medial leg
reflex: patellar

Question 33

L4 injury disc involved

Answer 33

L3-4

Question 34

L4 radiculopathy %

Answer 34

5-10% of lower extremity

Question 35

L5 motor, sensory, reflex

Answer 35

M: foot dorsiflexion, big toe extension, foot eversion/inversion
S: dorsum of foot
R: none

Question 36

L5 disc involved, % of radiculopathies

Answer 36

L4-5; 40% of lower extremity

Question 37

S1 motor, sensory, reflex

Answer 37

M: foot plantarflexion
S: lateral foot, sole of foot
R: Achilles

Question 38

S1 disc involved, % radiculopathies

Answer 38

L5-S1; 45% of lower extremity radiculopathies

Question 39

possible consequence of complete cord transection

Answer 39

spinal shock followed by UMN signs

Question 40

Brown-Sequard

Answer 40

Hemisection of spinal cord

• ipsilateral loss of position and strength below lesion
• contralateral loss of pinprick and temperature sensation

Question 41

Posterolateral column syndrome

Answer 41

• loss of posterior and lateral columns

- bilateral loss of position/vibration and strength

Question 42

Myelopathy with radiculopathy

Answer 42

any or all 3 tracts affected (esp. CS)

E.g – cervical spinal stenosis, may be congeital or degenerative