Look
Front
Appropriately disrobed / generalised disease / orthotics
Side
Sagittal alignment entire spine
Back
Wasting / lumbar spine coronal plane alignment / spinal dysraphism
Gait
Wide based gait
Heel Toe
Specific Tests
Rhomberg
Arms outstretched in front
- close eyes
- positive if lose balance once visual aids removed
Finger escape sign
Hold hands out, fingers together
- medial two fingers drift apart
- takes 30 – 60 seconds
Grip and Release / disdiadokinesis
20 times in 10 seconds
- myelopathy patients much slower
Sit
Feel
Palpate neck
- central / paraspinal / trapezius / posterior triangle
Move
ROM
Flexion (should be able to get chin to chest)
Extension (should be able to get forehead parallel to ground)
Ear to shoulder
Rotation 80o
Tone
Cogwheel rigidity
Clonus in feet
Power
ASIA (American Spinal Injury Association)
- look for interosseous wasting
- power often especially decreased in hands
Reflexes
Hyper-reflexia
1. Hoffman Reflex
- flexion of ipsilateral IPJ of index and thumb when long finger DIPJ flexed
- extension of neck increases sensitivity
2. Inverted Brachioradialis Reflex
- spontaneous flexion of digits when BR reflex elicited
- indicates cord compression at C5 and C6 / commonest levels
3. Babinski Reflex
Sensation
Decreased sensation globally / reduced vibration / proprioception
Questions
What is differential?
Central / cerebellar cause / Demyelinating disorder
How do you differentiate Cerebellar causes?
Nystagmus / Jaw Jerk