Spinal cord compression physical examination: Difference between revisions
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{{Spinal cord compression}} | {{Spinal cord compression}} | ||
{{CMG}} ; {{AE}} {{ADG}} | |||
==Overview== | |||
The most significant physical examination findings in acute cases is point tenderness of back. Other physical examination findings include [[paralysis]] of limbs below the level of compression, [[hypoaesthesia|decreased sensation]] below the level of compression, [[Lhermitte's sign]] (intermittent shooting electrical sensation), [[hyperreflexia]], [[Babinski sign]] positive.<ref name="RopperLongo2017">{{cite journal|last1=Ropper|first1=Alexander E.|last2=Longo|first2=Dan L.|last3=Ropper|first3=Allan H.|title=Acute Spinal Cord Compression|journal=New England Journal of Medicine|volume=376|issue=14|year=2017|pages=1358–1369|issn=0028-4793|doi=10.1056/NEJMra1516539}}</ref> | |||
==Physical Examination== | ==Physical Examination== | ||
===General Appearance=== | |||
*Patients may appear in acute distress due to [[back pain]]. | |||
===Vital signs=== | |||
*[[Hypotension]] in case of [[neurogenic shock]] | |||
*[[Hypothermia]] | |||
===Back=== | |||
*Point tenderness at the site of compression | |||
*Decreased range of motion | |||
===Neurologic=== | ===Neurologic=== | ||
* [[Paralysis]] of limbs below the level of compression | * [[Paralysis]] of limbs below the level of compression | ||
* [[ | * [[Hypoaesthesia]] below the level of compression | ||
* [[Lhermitte's sign]] (intermittent shooting electrical sensation) | * [[Lhermitte's sign]] (intermittent shooting electrical sensation) | ||
* [[Hyperreflexia]] may be present. | * [[Hyperreflexia]] may be present. | ||
* Upward plantar reflex ([[Babinski sign]]) | |||
{| class="wikitable" | |||
! colspan="2" |ASIA Impairment Scale for Traumatic Spinal Cord Injury♠ | |||
|- | |||
|Grade | |||
|Impairment | |||
|- | |||
|A | |||
| | |||
* Complete: no sensory or motor function is preserved in segments S4–S5. | |||
|- | |||
|B | |||
| | |||
* Sensory incomplete: sensory but not motor function is preserved below the neurologic level of injury and includes the S4–S5 segment | |||
* No motor function is preserved more than three levels below the motor level on either side of the body. | |||
|- | |||
|C | |||
| | |||
* Motor incomplete: motor function is preserved at the most caudal sacral segments for voluntary anal contraction, or sensory function is preserved at the most caudal sacral segments (S4–S5), with some sparing of motor function more than three levels below the motor level on either side of the body. | |||
|- | |||
|D | |||
| | |||
* Motor incomplete: motor function is incomplete as defined above, with muscle power ≥3 for at least half the key muscle functions below the neurologic level of injury.† | |||
|- | |||
|E | |||
| | |||
* Normal: sensory and motor function are normal. | |||
|- | |||
| colspan="2" |♠ Data are adapted from the American Spinal Injury Association (ASIA). | |||
† Muscle power is graded on a scale from 0 (no muscle contraction) to 5 (normal power). | |||
|} | |||
== References == | == References == | ||
Latest revision as of 12:59, 25 April 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
The most significant physical examination findings in acute cases is point tenderness of back. Other physical examination findings include paralysis of limbs below the level of compression, decreased sensation below the level of compression, Lhermitte's sign (intermittent shooting electrical sensation), hyperreflexia, Babinski sign positive.[1]
Physical Examination
General Appearance
- Patients may appear in acute distress due to back pain.
Vital signs
- Hypotension in case of neurogenic shock
- Hypothermia
Back
- Point tenderness at the site of compression
- Decreased range of motion
Neurologic
- Paralysis of limbs below the level of compression
- Hypoaesthesia below the level of compression
- Lhermitte's sign (intermittent shooting electrical sensation)
- Hyperreflexia may be present.
- Upward plantar reflex (Babinski sign)
| ASIA Impairment Scale for Traumatic Spinal Cord Injury♠ | |
|---|---|
| Grade | Impairment |
| A |
|
| B |
|
| C |
|
| D |
|
| E |
|
| ♠ Data are adapted from the American Spinal Injury Association (ASIA).
† Muscle power is graded on a scale from 0 (no muscle contraction) to 5 (normal power). | |
References
- ↑ Ropper, Alexander E.; Longo, Dan L.; Ropper, Allan H. (2017). "Acute Spinal Cord Compression". New England Journal of Medicine. 376 (14): 1358–1369. doi:10.1056/NEJMra1516539. ISSN 0028-4793.