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Standard examination templates for when spinal injury or radiculopathy are suspected. Written in the negative. Knowledge refresher at the end.

Step 1: Is the Cord Intact? + Focused Lower Limb Examination

Review Upper/Lower limb myotomes and dermatomes as applicable (See below)

Vibration sensation and proprioception to the ankle/toes present bilaterally (dorsal column intact)
Motor function to the lower limbs (L2 HE / L3 KE / L4 ADF / L5 GTE / S1 APF) is equal bilaterally (corticospinal tract intact)
Cold sensation, tested with ice, demonstrates no spinal level, including to lower limb and sacral/perianal dermatomes. (spinothalamic tract intact)

Step 2: Excluding Cauda Equina / Conus Medullaris syndromes

Excluding Conus Medullaris syndrome, there are no UMN signs: no symmetrical LL weakness. No hyperreflexia of the knee jerk reflex. History is not suggestive either, as there is no early bowel/bladder dysfunction or sudden back pain with perianal anaesthesia.

Excluding Cauda Equina (L2) syndrome, there is no LL hyporeflexia, numbness or parasthesia. No asymmetrical weakness, No urinary retention (high PVR), normal voluntary anal contraction. There is no history of fecal incontinence. No saddle analgesia.

Upper and Lower Limb Dermatomes / Myotomes / Reflex Arcs

Lower Limb:
Sensation present to:
– perianal (S3-S5)
– back of thigh (S2) and Leg (S1)
– medial (L4) and lateral (L5) leg
– anterior groin / thigh (L1-L3)
Equal power on:
– Hip Flexion (L2)
– Knee Extensors (L3)
– Ankle Dorxiflesion (L4)
– Great toe extensors (L5)
– Ankle plantar flexion (S1)
– Plantars downgoing. (S1)
Normal ankle deep tendon reflex. (sciatic/tibial S1/S2)
Normal patella reflex (femoral n. L2/L3/L4)
Normal voluntary anal contraction (S2-4)

Upper Limb:
Sensation present to:
– Lateral Arm (C5)
– Lateral Forearm (C6)
– Middle Finger (C7)
– Little Finger (C8)
– Medial Arm (T1)
Equal power on:
– Elbow Flexors (C5)
– Wrist Extensors (C6)
– Elbow Extensors (C7)
– Finger Flexors/Extensors (C8)
– Finger Abduction of Little Finger (T1)
Normal biceps reflex (C5/C6)

Cord Syndrome Refresher

Dorsal Column: Vibration and Proprioception
Corticospinal tract: Motor
Spinothalamic: Pain and temperature (decussates in cord, not medulla)

Anterior Cord (hyperflexion injury)
Only vibration and proprioception intact (dorsal columns intact)
Pain, temp, motor gone. (others gone)
Central Cord (hyperextenion injury)
Patchy, inconsistent neurology
“Patchy distal upper motor and sensory loss”
Loss of MUD-E, Motor>Sensory, Upper>Lower, Distal>Proximal – from Extension injury
Hemisection Brown Sequard (penetrating injury)
Ipsilateral vibration, proprioception, motor loss
Contralateral pain/temperature loss.
Spinal Shock
“spinal concussion”.
Transient flaccid paralysis/areflexia from cord oedema.
Neurogenic Shock (Sympathetic Chain Disruption)
Hypotension and bradycardia.
Lesions above T6.