Myelopathies

Question 1

Degenerative cervical myelopathy

Answer 1

RFs: smoking (affects discs), genetics, occupation

Symptoms:
1) Pain affecting neck, upper or lower limbs
2) Loss of motor function - dexterity, arm or leg weakness/stiffness
3) Loss of sensory function -numbness
4) Loss of autonomic function - urinary or faefcal incontinence/impotence
5) Hoffman’s signs - flick one finger on patients hand - positive = reflex twitching or other fingers on same hand

Gold standard test: MRI c-spine - disc degeneration with cord signal change

Mangagement:
- urgent referral to neurosurgery/orthopaedic spinal surgery - decompression within 6m offers best chance of full recovery
- physio only by specialist service as manipulation can cause more damage.
- Ongoing f/u post surgery as pathology can recur at adjacent spinal laevels

Average first appointment to diagnosis > 2y / 5 appointments

Question 2

C4 nerve root impingement

Answer 2

Pain radiating to shoulder and upper arm

Sensory changes over lower nefck, shoulder and upper chest.

Question 3

C5 nerve root impingement

Answer 3

Pain radiating to lateral shoulder and upper arm

Weakness in shoulder abduction (deltoid) and external rotation (infraspinatus)

Sensory changes over lateral aspect of upper arm

Question 4

C6 nerve root impingement

Answer 4

Pain radiating along lateral forearm into thumb and index finger

Weakness in elbow flexion (biceps) and wrist extension (extensor carpi radialis longus/brevis)

Sensory changes affect mainly thumb and index finger

Question 5

C7 nerve root impingement

Answer 5

Pain raditing along medial forearm into ring and little fingers

Weakness in finger flexion (flexor digitorum profundus) and intrinsic hand muscles

Sensory changes little and ring fingers

Question 6

C2 dermatome

Answer 6

Posterior half of skull (cap)

Question 7

C3 dermatome

Answer 7

High turle neck shirt

Question 8

C4 dermatome

Answer 8

Low-collar shirt

Question 9

C5 dermatome

Answer 9

Ventral axial line of upper limb

Question 10

C6 dermatome

Answer 10

Thumb and index - make a 6 with your L hand by touching the tip of the thumb and index finer together

Question 11

C7 dermatome

Answer 11

Middle finger and palm of hand

Question 12

C8 dermatome

Answer 12

Ring and little finger

Question 13

T4 dermatome

Answer 13

Nipples

Question 14

T5 dermatome

Answer 14

Inframammary fold

Question 15

T6 dermatome

Answer 15

Xiphoid process

Question 16

T7 dermatome

Answer 16

Umbilicus - belybuT-TEN

Question 17

L1 dermatome

Answer 17

Inguinal ligament - L for ligament 1 for 1nguinal

Question 18

L4 dermatome

Answer 18

Knee caps. - down on aLL 4’s

Question 19

L5 dermatome

Answer 19

Big toe, dorsum of foot except lateral aspect - L5 - largest of all 5 toes

Question 20

S1 dermatome

Answer 20

Lateral foot, small toe - S1 = the smallest one

Question 21

S2/3 dermatome

Answer 21

Genitalia

Question 22

Transverse myelitis