Evaluation of the spine Flashcards

1
Q

Lhermitte’s Sign

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Lasegu’s Sign

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

At what vertebral level is the conus medullaris found?

A

L1/L2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Biceps reflex - which nerve roots?

A

C5, C6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Brachioradialis reflex - which nerve roots?

A

C6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Triceps reflex - which nerve roots?

A

C6, C7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Patellar reflex - which nerve roots?

A

L2, L3, L4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Achilles reflex - which nerve roots?

A

S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Nerve root L4 testing - motor, sensory, reflex

A

Motor - Psoas, Quads

Sensory - Knee, medial leg

Reflex - Patellar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

L5 nerve root testing - motor, sensory, reflex

A

Motor - foot dorsiflexion, big toe extension, foot eversion/inversion

Sensory - Dorsum of foot, great toe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

S1 nerve root testing - motor, sensory, reflex

A

Motor - foot plantarflexion

Sensory - lateral foot, small toe, sole of foot

Reflex - Achilles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Nerve root C5 testing - motor, sensory, reflex

A

Motor - deltoid, infraspinatus, biceps

Sensory - shoulder, upper lateral arm

Reflex - biceps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Nerve root C6 testing - motor, sensory, reflex

A

Motor - wrist extensors, biceps

Sensory - 1st and 2nd digits of hand

Reflex - biceps, brachioradialis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Nerve root C7 testing - motor, sensory, reflex

A

Most common radiculopathy of the UE (40-50%); usually involves herniation of the C6-C7 IVD

Motor - triceps

Sensory - 3rd digit

Reflex - Triceps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Abdominal reflex

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Upper motor neuron signs

A

Spasticity
Hyperreflexia
Extensor Plantar Reflex (Babinski’s Sign)

17
Q

Lower motor neuron signs

A
Atrophy
Fasciculations 
Flaccidity
Decreased DTRs
Flexor Plantar Response
18
Q

Spinal Shock

A

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

19
Q

Cervical Stenosis

A

Congenital or acquired narrowing of central cervical spinal canal

Can result in UMN signs in legs +/- bladder dysfunction

20
Q

Complete Cord Transection

A

Affects all ascending sensory and descending motor/autonomic tracts

Deficit: sensory and motor below the lesion; root sign at site

21
Q

Central Lesions

A

Ex: Syringomyelia, ependymoma, cord contusion

Tracts: Crossing ST

Deficit: Pain/temperature loss at level of lesion; sparing of position sensation

22
Q

Posterior Column Syndrome

A

Ex: Tabes Dorsalis (neurosyphilis)

Tracts: Posterior Column

Bilateral loss of position and vibration sense

23
Q

Combined anterior horn cell / pyramidal tract sydnrome

A

Ex: ALS

Tracts: Corticospinal, LMN cells in cord

Deficit: Loss of bilateral strength, fasciculations, atrophy

24
Q

Brown-Sequard Syndrome

A

Ex: Compression by herniated discs

Tracts: Crossed spinothalamic, uncrossed posterior column, crossed corticospinal

Below lesion, loss of contralateral pain/temperature, ipsilateral position and strength

25
Posterolateral Column Syndrome
Ex: B12 deficiency (subacute combined degeneration) Tracts: Posterior Column, Corticospinal Deficit: Bilateral los sof position, vibration, and strength
26
Anterior Horn Cell Syndrome
Ex: Polio Deficits: Bilateral loss of strength, fasciculations, flaccidity, decreased DTRs
27
Anterior Spinal Artery Occlusion
Tracts: Corticospinal + Spinothalamic Deficit: B/L loss of strength, pain, temperature; sparing of position sense
28
Pyramidal Tract Syndrome
Ex: Primary lateral sclerosis Tracts: Corticospinal Deficit: Bilateral UMN weakness with spastic gait, hyperreflexia; sparing of sensory tracts
29
Myelopathy with Radiculopathy
Ex: Cervical spinal stenosis Deficit: Bilateral UMN syndrome with spastic gait, hyperreflexia, ipsilateral/contralateral root signs, possible bladder dysfunction
30
Conus Medullaris
Dysfunction of the cord tip (S2-S5) Early bladder, bowel, and sexual dysfunction Late pain in thighs and buttocks
31
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)
32
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
33
Hoffmann's sign
Heightened finger flexor reflex Suggests an UMN lesion affecting the hands