Clinical Evaluation of the Spine and Spinal Cord Flashcards
UMN
Immediate muscle weakness and hypotonia, hyporeflexia or areflexia (“Spinal Shock”)
Followed by spasticity and HYPERreflexia in days to weeks (including extensor plantar response: Babinski’s sign)
SPASTIC PARESIS
LMN
Muscle weakness, hypotonia, hyporeflexia, areflexia are all immediate and long-lasting
FLACCID PARESIS
FASCICULATIONS
ATROPHY
Paresthesia,
An abnormal sensation, can include burning, pricking, tickling, or tingling. Sometimes characterized as “pins and needles”
Myelopathy
Disorder resulting in spinal cord dysfunction
Radiculopathy
Sensory and/or motor dysfunction due to injury to a nerve root.
Myotome,
Muscles innervated by an individual motor root.
Dysesthesia,
Impairment of sensation short of anesthesia
Dermatome,
Cutaneous area served by an individual sensory root.
Hypoesthesia
decreased sensation
Hyperesthesia
excessive sensation
Anesthesia
loss of sensation
Paresthesia
numbness, tingling, burning sensation
Dysesthesia
numbness, tingling, burning sensation, but usually when this is more unpleasant
Paresis
decreased strength
Plegia
complete loss of strength
C5 dermatome
typically covers back of shoulder and lateral arm
C6 dermatome
typically covers thumb, usually second digit too
C7 dermatome
usually covers third digit (middle finger)
T4 dermatome**
nipple line**
T6 dermatome**
xyphoid process**
T10 dermatome**
umbilicus**
L4 dermatome:
Typically kneecap, medial leg
L5 dermatome
dorsum of foot, great toe
S1 dermatome:
lateral foot, small toe, sole of foot.
Lhermitte’s sign
Pain
Evidence of cervial mylophathy
Spurling’s sign
Pain
shock- narrowing- (+foraminal compression test)
Lasegue’s sign
Pain
+straight leg raising test, SLR
shooting pain down sciatic
Assessment of Pain (and most other symptoms)
Location Quality Quantity (0-10, VAS) Time Course (Tempo!) Aggravating and Alleviating factors
conus medullaris syndrome
x
cauda equina syndrome
surgical emergency
C1, 2, 3, 4, 5, 6, 7 roots exit ___________ same numbered vertebra (e.g. C7 ______ C7).
above
C8 below C7 and all other roots exit _________– same numbered vertebra (e.g. T1 exits ____T1).
below
the tip of cord; supplies bladder, rectum, & genitalia
The Conus medullaris (S3-S5)
(Horse’s tail) is formed by the LS roots within the lumbosacral cistern
The Cauda equina
Lower cervical: vertebra # overlies cord segment # + ____
+1
C6 bone, C7 cord
Upper thoracic: vertebra # overlies cord segment # + ____
+2 (T4 bone, T6 cord)
Lower thoracic/lumbar: vertebra # overlies cord segment # _____
+2- 3
T 11bone, L1-2 cord
Lower edge of the L1 vertebral body overlies the:
cord tip (conus medullaris)
Know everthing about:
c5,c6, c7
L4, L5, s1
typically covers thumb, usually second digit too.
C6 dermatome
usually covers third digit (middle finger)
C7 dermatome:
typically covers back of shoulder and lateral arm
C5 dermatome
Typically kneecap, medial leg
L4 dermatome:
dorsum of foot, great toe
L5 dermatome:
lateral foot, small toe, sole of foot.
S1 dermatome:
Disk herniation in ____ usually does not affect the exiting nerve root
Lumbar
Herniation will affect the one below
L4 herniation will impinge L5 nerve root
Motor
Deltoid
Infraspinatus
biceps
C5
Reflex
biceps
Motor
Wrist extens, biceps
C6
reflex
Biceps, brachiorad
Motor
Triceps
C7
reflex: Triceps
Motor
Psoas, Quads
L4
Foot dorsiflexion, big toe extension, foot eversion and inversion
L5
Foot plantarflexion
S1
reflex
achilles
Bowel Bladder and sexual fx
can be an indication of severity
Incontinence occurs when neural pathways that innervate the bladder are interrupted or when there are physical problems with the pelvic floor and sphincter muscles. Incontinence is an important symptom, and if it occurs in association with other neurological deficits that localize to the spinal cord, this needs to be investigated aggressively.
detrusor (smooth) muscle, activated by the preganglionic parasympathetic outflow from the___________
S2-S4 segments.
The involuntary (smooth) sphincter, controlled by sympathetic outflow from the:
T10-L2 segments of the spinal cord
Skeletal muscle of the pelvic floor, innervated by alpha motor neurons from the
S2-S4 segments.
When the parasymp LMN are injured or their axons compressed /disrupted.
lesion results in weakness, atrophy, and hyporeflexia. The bladder does not contract and, if the sensory afferents are affected, no sensation of a full bladder will be perceived.
There may be overflow incontinence when the bladder cannot physically hold any more urine.
Flaccid Bladder:
Descending pathways involved in bladder control are cut or otherwise injured (must be injured bilaterally to yield deficit)
There is initial flaccidity of the bladder, and with time, spasticity can develop and the bladder contracts with small degrees of stretch.
This causes urinary frequency and urgency.
Spastic Bladder:
Damage to the descending tracts can also produce problems with coordination between the sympathetic outflow (which must be inhibited during voiding) and parasympathetic outflow (which must be activated).
If the detrusor and involuntary sphincter contract simultaneously, a condition known as detrusor dyssynergia can develop, leading to high bladder pressures and ureteral reflux with potential for kidney damage.
Spastic Bladder:
