Evaluation of the spine Flashcards
Lhermitte’s Sign
Neck extension results in “electric shock” sensation down the back and into the arms
Attributed to posterior column disease, often secondary to MS, disc herniation, B12 deficiency
Lasegu’s Sign
Straight leg raise test - Flex patient’s leg and dorsiflex the foot; sharp, shooting pain is a positive sign
Tests L5/S1 (Sciatic) nerve roots for impingement
At what vertebral level is the conus medullaris found?
L1/L2
Biceps reflex - which nerve roots?
C5, C6
Brachioradialis reflex - which nerve roots?
C6
Triceps reflex - which nerve roots?
C6, C7
Patellar reflex - which nerve roots?
L2, L3, L4
Achilles reflex - which nerve roots?
S1
Nerve root L4 testing - motor, sensory, reflex
Motor - Psoas, Quads
Sensory - Knee, medial leg
Reflex - Patellar
L5 nerve root testing - motor, sensory, reflex
Motor - foot dorsiflexion, big toe extension, foot eversion/inversion
Sensory - Dorsum of foot, great toe
S1 nerve root testing - motor, sensory, reflex
Motor - foot plantarflexion
Sensory - lateral foot, small toe, sole of foot
Reflex - Achilles
Nerve root C5 testing - motor, sensory, reflex
Motor - deltoid, infraspinatus, biceps
Sensory - shoulder, upper lateral arm
Reflex - biceps
Nerve root C6 testing - motor, sensory, reflex
Motor - wrist extensors, biceps
Sensory - 1st and 2nd digits of hand
Reflex - biceps, brachioradialis
Nerve root C7 testing - motor, sensory, reflex
Most common radiculopathy of the UE (40-50%); usually involves herniation of the C6-C7 IVD
Motor - triceps
Sensory - 3rd digit
Reflex - Triceps
Abdominal reflex
Elicited by drawing a line away from the umbilicus along the diagonals of the 4 abdominal quadrants; a normal reflex draws the umbilicus toward the direction of the line that is drawn
Upper reflex evaluates T8, T9, T10
Lower reflex evaluates T10, T11, T12
Upper motor neuron signs
Spasticity
Hyperreflexia
Extensor Plantar Reflex (Babinski’s Sign)
Lower motor neuron signs
Atrophy Fasciculations Flaccidity Decreased DTRs Flexor Plantar Response
Spinal Shock
Occurs with acute, complete spinal cord transection
Acutely, exam shows flaccid weakness, absent tone, absent DTRs, and absent autonomic function (bladder function, sweat)
By 3-4 months, exam shows UMN spasticity, hyperactive DTRs, Babinski sign
Cervical Stenosis
Congenital or acquired narrowing of central cervical spinal canal
Can result in UMN signs in legs +/- bladder dysfunction
Complete Cord Transection
Affects all ascending sensory and descending motor/autonomic tracts
Deficit: sensory and motor below the lesion; root sign at site
Central Lesions
Ex: Syringomyelia, ependymoma, cord contusion
Tracts: Crossing ST
Deficit: Pain/temperature loss at level of lesion; sparing of position sensation
Posterior Column Syndrome
Ex: Tabes Dorsalis (neurosyphilis)
Tracts: Posterior Column
Bilateral loss of position and vibration sense
Combined anterior horn cell / pyramidal tract sydnrome
Ex: ALS
Tracts: Corticospinal, LMN cells in cord
Deficit: Loss of bilateral strength, fasciculations, atrophy
Brown-Sequard Syndrome
Ex: Compression by herniated discs
Tracts: Crossed spinothalamic, uncrossed posterior column, crossed corticospinal
Below lesion, loss of contralateral pain/temperature, ipsilateral position and strength
Posterolateral Column Syndrome
Ex: B12 deficiency (subacute combined degeneration)
Tracts: Posterior Column, Corticospinal
Deficit: Bilateral los sof position, vibration, and strength
Anterior Horn Cell Syndrome
Ex: Polio
Deficits: Bilateral loss of strength, fasciculations, flaccidity, decreased DTRs
Anterior Spinal Artery Occlusion
Tracts: Corticospinal + Spinothalamic
Deficit: B/L loss of strength, pain, temperature; sparing of position sense
Pyramidal Tract Syndrome
Ex: Primary lateral sclerosis
Tracts: Corticospinal
Deficit: Bilateral UMN weakness with spastic gait, hyperreflexia; sparing of sensory tracts
Myelopathy with Radiculopathy
Ex: Cervical spinal stenosis
Deficit: Bilateral UMN syndrome with spastic gait, hyperreflexia, ipsilateral/contralateral root signs, possible bladder dysfunction
Conus Medullaris
Dysfunction of the cord tip (S2-S5)
Early bladder, bowel, and sexual dysfunction
Late pain in thighs and buttocks
Cauda equina syndrome
Dysfunction of spinal roots L1-S5
Early root pain radiating to legs
Late bladder, bowel, and sexual dysfunction
Leg weakness and decreased DTRs (LMN)
Where does parasympathetic control of the bladder come from?
Pre-ganglionic parasympathetic cells in the S2, S3, and S4 levels of the spinal cord; these pre-ganglionic parasympathetics send axons out the ventral roots S2, S3, and S4 to synapse on post-ganglionic parasympathetic cells in ganglia near the bladder
Hoffmann’s sign
Heightened finger flexor reflex
Suggests an UMN lesion affecting the hands
