Require
1. Diagnose Myelopathy
- heel toe
- Rhomberg
- finger escape
- clench and release
- high tone
- inverted BR / Hoffmans
2. Identify Neurology
Look
Front
- Position of head & neck
- Torticollis
- SCM tumour
- wasting limbs
Side
- Kyphosis
- Webbed neck
Back
- Low posterior hairline
- Sprengel shoulder
- Wasting Peri-scapular
Gait
Toe walking (S1)
Heel walking (L4)
Toe-to-heel walking
- looking for balance difficulty
- ataxia
Romberg
- assess dorsal column / proprioception
- stand feet together, close eyes
- positive if sway or fall
Finger escape
- hold hands out
- try to keep LF together with other fingers
Clench and release
- should be > 20 times in 10 seconds
Feel
Spinous processes
Paravertebral - trapezius
Posterior triangle
Sternomastoid
Move
Forward flexion
- Chin to chest
- Total range of F/E is 130°
- Alanto Occiptial Joint (40% Nodding) / Subaxial (60% Forward translation)
Extension
- Plane of nose & forehead horizontal
Rotation
- Chin nearly to plane of shoulder 80°
- Atlantoaxial Joint (50%) / Subaxial (50%)
Lateral Flexion
- Ear to shoulder with shrug 45°
- Occurs at lower Cervical vertebrae
Special Tests
Spurling's Sign
- Nerve root compression is confirmed by Spurling's sign
- extension and rotation toward the symptomatic side reproduces the radicular symptoms
Thoracic Outlet Syndrome Tests
- Addsons
- Roos
Neurological Exam
Tone
High tone / clasp knife rigidity
Power
C5 - Deltoid / Biceps
C6 - Wrist Extension
C7 - Triceps
C8 - Finger Flexion
T1 - Interossei
Reflexes
C5 - Biceps
C6 - Brachioradialis
C7 - Triceps
Myelopathy reflexes
Inverted Brachioradialis
- tap on BR
- flexion of thumb and index finger
Hoffmann's reflex
- forced flexion of MF DIPJ
- reflex finger and thumb flexion is elicited
Scapulohumeral Reflex
- tapping tip of spine of scapula
- brisk elevation of scapula & abduction of the humerus
- positive in > 95% of myelopaths
Jaw Jerk
- a cerebellar sign
- distinguishes myelopathy from cerebellum
Sensation
C5 - deltoid
C6 - lateral forearm, thumb
C7 - middle finger, posterior arm
C8 - little finger
T1 - medial forearm
T2 - medial arm