Spine Exam/Levels

Question 1

Deltoid muscle action tests which spinal level

Answer 1

C5

Question 2

Biceps level

Answer 2

C6

Question 3

Triceps level

Answer 3

C7

Question 4

Finger flexion

Answer 4

C8

Question 5

Intrinsics (abduction)

Answer 5

T1

Question 6

Hip flexors

Answer 6

L2-3

Question 7

Quads/Tibialis anterior

Answer 7

L4

Question 8

Tibialis anterior/EHL/Hip Abductor

Answer 8

L5

Question 9

Gastrocnemius

Answer 9

S1

Question 10

Biceps brachii reflex tests what nerve and what level

Answer 10

Musculocutaneous nerve, C5-6

Question 11

Triceps brachii reflex

Answer 11

Radial nerve, C6-7

Question 12

Brachioradialis reflex

Answer 12

Radial nerve, C5-6

Question 13

Knee (quadriceps) reflex

Answer 13

Femoral nerve, L2-L4

Question 14

Ankle (gastrocnemius) reflex

Answer 14

Tibial nerve, S1

Question 15

Jaw jerk reflex

Answer 15

CN V (trigeminal nerve), tests pons

Question 16

Sacral roots- “sacral sparing”

Answer 16

Perianal sensation
Rectal tone
Sacral sparing is a sign of incomplete spinal cord injury (muscle loss but cutaneous sensation is there)

Question 17

C67 disc herniation affects

Answer 17

C7 nerve root
Innervates the triceps
Provides sensation to long finger

Question 18

Rule for disc herniations*

Exceptions*

Answer 18

The higher number nerve root is compressed: C45–> affects C5
L45–>affects L5
The higher number root in lumbar is traversing past the disc herniation, which is usually posteriolateral

T spine*: ex) T78 affects T7
Far lateral herniation in L spine: ex) L45 affects L4
C7-T1: C8 nerve root is affected**

Question 19

Cervical radiculopathy

Dx:

Answer 19

Means nerve compression
Higher disc herniations can have radiating pain in shoulder
Most common: C45, C56, C67
Nonspecific neck/shoulder pain with C2/3 disease
Atypical sx: chest pain in 15% of C7 radiculopathies

Dx: shoulder pathology, peripheral entrapment neuropathy (ex is carpal tunnel syndrome)

Question 20

Lumbar disc herniation presentation
Clinical test for L4-S1 pathology:
L2-L4 pathology test:

Answer 20

Truncal shift- shift body away from nerve root to feel better
Limp- pain vs. weakness (Trendelenburg)
Straight leg raise- sciatic nerve
Femoral nerve stretch test

Question 21

Disc herniations- urgent surgery if

Answer 21

Cauda equina syndrome- bladder dysfunction, groin numbness

Progressive weakness

Question 22

Lumbar stenosis presentation

Cause

Answer 22

Want to unpinch their nerves by leaning forward

Lateral recess- where traversing nerve root is, affected by hypertrophic facet joint, growing into traversing root and pinching it

Trefoil shaped stenosis- as facet grows from both sides and disc builders backwards

Question 23

Night pain is pathognomic for

Answer 23

Discitis

Question 24

What spinal cord levels innervate shoulder abduction

Answer 24

C5,6,7

Question 25

What spinal cord levels innervate elbow flexion

Answer 25

C5-6

Question 26

What spinal cord levels innervate elbow extension

Answer 26

C6-C7

Question 27

What spinal cord levels innervate Wrist extension

Answer 27

C6-C7

Question 28

What spinal cord levels innervate wrist flexion

Answer 28

C7-C8

Question 29

What spinal cord levels innervate finger flexion

Answer 29

C7-C8, T1

Question 30

What spinal cord levels innervate finger extension

Answer 30

C7-C8

Question 31

What spinal cord levels innervate thumb

Answer 31

C8-T1