Myelopathy Exam

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

 

Finger escape

 

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