Neurologic Screening
Upper Quarter Neurological Screen for Possible Neurological Conditions
Neurological Symptoms
The presence of neurological symptoms always deserves special attention. The systems review is extremely important to rule in and out conditions. The neurological examination attempts to differentiate between a nerve root problem or spinal cord compression as well as to assess the normal conduction of the central and peripheral nervous systems. It is extremely important when indicated because the cervical spine is the only region that has more nerve roots than vertebral levels. The presence of any upper motor neuron involvement is cause for immediate referral.
Possible Upper Motor Neuron Involvement
Cervical Myelopathy
*Cause for immediate referral*
Involves an injury to the spinal cord itself
Associated with:
b. Hyperreflexia
c. Visual and balance disturbances
d. Ataxia
e. Sudden changes in bowel and bladder function
Other Clinical Signs and Symptoms of Cervical Myelopathy:
Pain Distribution from Cervical Structures:
The presence of neurological symptoms always deserves special attention. The systems review is extremely important to rule in and out conditions. The neurological examination attempts to differentiate between a nerve root problem or spinal cord compression as well as to assess the normal conduction of the central and peripheral nervous systems. It is extremely important when indicated because the cervical spine is the only region that has more nerve roots than vertebral levels. The presence of any upper motor neuron involvement is cause for immediate referral.
Possible Upper Motor Neuron Involvement
- DTRs for hyper-reflexia (upper and lower extremities)
- Babinski sign
- Hoffman's reflex
- Inverted supinator sign
- Clonus
- Muscle tone of upper and lower extremities for velocity dependent hypertonia sensory examination for non-dermatonal distribution of impairment in upper and lower extremities.
Cervical Myelopathy
*Cause for immediate referral*
Involves an injury to the spinal cord itself
Associated with:
- Multisegmental paresthesias
- Upper motor neuron (UMN) signs and symptoms:
b. Hyperreflexia
c. Visual and balance disturbances
d. Ataxia
e. Sudden changes in bowel and bladder function
Other Clinical Signs and Symptoms of Cervical Myelopathy:
- Wide-based spastic gait
- Clumsy hands
- Visible change in handwriting
- Difficulty manipulating buttons or handling coins
- Positive Babinski test
- Positive Hoffman sign
- Lhermitte's sign
- Urinary retention followed by overflow incontinence
Pain Distribution from Cervical Structures:
Structure
Occipital Condyles Occipitocervical tissues C1 posterior (dorsal) ramus C1-2 C3 posterior (dorsal) ramus |
Pain Area
Frontal Frontal Orbit, frontal, and vertex Temporal and suboccipital Occiput, mastoid, and frontal |
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