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EXAMINATION
Wasting Gibbus
Skin
- Colour : reflects vascular status, pigmentation
- Scars
- Bruise/wounds/ulcerations
The sum of all 20 muscle yields a total motor score for each
patient, with a maximum possible score of 100 points for
patients with no weakness
(no weakness = 100 points)
Level of Neurological Impairment
Injury is complete if there is :
- No voluntary anal contraction
- S4-5 sensory scores = 0
- Anal sensation = No
Otherwise injury is incomplete
Level of Neurological Impairment
The ASIA neurological impairment scale is based on the Frankel classification of spinal cord
injury:
CATEGORY DESCRIPTION
A = Complete No motor or sensory function is preserved in the sacral
segments S4-S5
Cremasteric (L1,2)
Anal (S4,5)
Used to stress the femoral nerve and the mid lumbar (L2-L4) nerve
roots
The examiner extends the knee while extending the hip
approximately 15. The knee is then flexed to further stretch the
femoral nerve.
The patients back must be straight and not hyperextended.
Positive: if pain radiates down the anterior thigh.
Bowstring Test
Cram test/popliteal pressure test
Test position:
Patient supine
Action:
Examiner performs a passive straight leg raise on involved side
If subjects reports radiating pain, examiner flexes the subjects knee to
approximately 200 in attempt to reduce pain
Pressure then applied to popliteal area to reproduce radicular pain
Positive finding:
Painful radicular reproduction with popliteal compression
Indicates sciatic nerve tension
Bowstring test
Waddells sign
- eliciting pain when pressing down on the top of the patients head or rotating the
shoulders and pelvis together should not be painful
Distracted straight leg raise
- if a patient complains of pain on straight leg raise, but not if the examiner extends the
knee with the patient seated at another time during the initial evaluation
Non-anatomic sensory changes: Regional sensory changes and regional weakness
- sensory loss in an entire extremity or side of the body or weakness that is non consistent
and jerky, ie "cogwheeling"
Overreaction
- Exaggerated painful response to a stimulus, that is not reproduced when the same
stimulus is given later