Clinical Evaluation of the Spine and Spinal Cord

Question 1

UMN

Answer 1

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

Question 2

LMN

Answer 2

Muscle weakness, hypotonia, hyporeflexia, areflexia are all immediate and long-lasting
FLACCID PARESIS
FASCICULATIONS
ATROPHY

Question 3

Paresthesia,

Answer 3

An abnormal sensation, can include burning, pricking, tickling, or tingling. Sometimes characterized as “pins and needles”

Question 4

Myelopathy

Answer 4

Disorder resulting in spinal cord dysfunction

Question 5

Radiculopathy

Answer 5

Sensory and/or motor dysfunction due to injury to a nerve root.

Question 6

Myotome,

Answer 6

Muscles innervated by an individual motor root.

Question 7

Dysesthesia,

Answer 7

Impairment of sensation short of anesthesia

Question 8

Dermatome,

Answer 8

Cutaneous area served by an individual sensory root.

Question 9

Hypoesthesia

Answer 9

decreased sensation

Question 10

Hyperesthesia

Answer 10

excessive sensation

Question 11

Anesthesia

Answer 11

loss of sensation

Question 12

Paresthesia

Answer 12

numbness, tingling, burning sensation

Question 13

Dysesthesia

Answer 13

numbness, tingling, burning sensation, but usually when this is more unpleasant

Question 14

Paresis

Answer 14

decreased strength

Question 15

Plegia

Answer 15

complete loss of strength

Question 16

C5 dermatome

Answer 16

typically covers back of shoulder and lateral arm

Question 17

C6 dermatome

Answer 17

typically covers thumb, usually second digit too

Question 18

C7 dermatome

Answer 18

usually covers third digit (middle finger)

Question 19

T4 dermatome**

Answer 19

nipple line**

Question 20

T6 dermatome**

Answer 20

xyphoid process**

Question 21

T10 dermatome**

Answer 21

umbilicus**

Question 22

L4 dermatome:

Answer 22

Typically kneecap, medial leg

Question 23

L5 dermatome

Answer 23

dorsum of foot, great toe

Question 24

S1 dermatome:

Answer 24

lateral foot, small toe, sole of foot.

Question 25

Lhermitte’s sign | Pain

Answer 25

Evidence of cervial mylophathy

Question 26

Spurling’s sign | Pain

Answer 26

shock- narrowing- (+foraminal compression test)

Question 27

Lasegue’s sign | Pain

Answer 27

+straight leg raising test, SLR | shooting pain down sciatic

Question 28

Assessment of Pain (and most other symptoms)

Answer 28

``` Location Quality Quantity (0-10, VAS) Time Course (Tempo!) Aggravating and Alleviating factors ```

Question 29

conus medullaris syndrome

Answer 29

x

Question 30

cauda equina syndrome

Answer 30

surgical emergency

Question 31

C1, 2, 3, 4, 5, 6, 7 roots exit ___________ same numbered vertebra (e.g. C7 ______ C7).

Answer 31

above

Question 32

C8 below C7 and all other roots exit _________-- same numbered vertebra (e.g. T1 exits ____T1).

Answer 32

below

Question 33

the tip of cord; supplies bladder, rectum, & genitalia

Answer 33

The Conus medullaris (S3-S5)

Question 34

(Horse's tail) is formed by the LS roots within the lumbosacral cistern

Answer 34

The Cauda equina

Question 35

Lower cervical: vertebra # overlies cord segment # + ____

Answer 35

+1 | C6 bone, C7 cord

Question 36

Upper thoracic: vertebra # overlies cord segment # + ____

Answer 36

+2 (T4 bone, T6 cord)

Question 37

Lower thoracic/lumbar: vertebra # overlies cord segment # _____

Answer 37

+2- 3 | T 11bone, L1-2 cord

Question 38

Lower edge of the L1 vertebral body overlies the:

Answer 38

cord tip (conus medullaris)

Question 39

Know everthing about:

Answer 39

c5,c6, c7 | L4, L5, s1

Question 40

typically covers thumb, usually second digit too.

Answer 40

C6 dermatome

Question 41

usually covers third digit (middle finger)

Answer 41

C7 dermatome:

Question 42

typically covers back of shoulder and lateral arm

Answer 42

C5 dermatome

Question 43

Typically kneecap, medial leg

Answer 43

L4 dermatome:

Question 44

dorsum of foot, great toe

Answer 44

L5 dermatome:

Question 45

lateral foot, small toe, sole of foot.

Answer 45

S1 dermatome:

Question 46

Disk herniation in ____ usually does not affect the exiting nerve root

Answer 46

Lumbar Herniation will affect the one below L4 herniation will impinge L5 nerve root

Question 47

Motor Deltoid Infraspinatus biceps

Answer 47

C5 Reflex biceps

Question 48

Motor | Wrist extens, biceps

Answer 48

C6 reflex Biceps, brachiorad

Question 49

Motor | Triceps

Answer 49

C7 reflex: Triceps

Question 50

Motor | Psoas, Quads

Answer 50

L4

Question 51

Foot dorsiflexion, big toe extension, foot eversion and inversion

Answer 51

L5

Question 52

Foot plantarflexion

Answer 52

S1 reflex achilles

Question 53

Bowel Bladder and sexual fx

Answer 53

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.

Question 54

detrusor (smooth) muscle, activated by the preganglionic parasympathetic outflow from the___________

Answer 54

S2-S4 segments.

Question 55

The involuntary (smooth) sphincter, controlled by sympathetic outflow from the:

Answer 55

T10-L2 segments of the spinal cord

Question 56

Skeletal muscle of the pelvic floor, innervated by alpha motor neurons from the

Answer 56

S2-S4 segments.

Question 57

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.

Answer 57

Flaccid Bladder:

Question 58

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.

Answer 58

Spastic Bladder:

Question 59

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.

Answer 59

Spastic Bladder: