Strength
On a scale of 1-5, what is the grade you would assign if someone has antigravity strength but can not provide any resistance to you?
3/5 strength
Your patient develops increased low back pain with numbness and tingling along the right dorsum of the foot. Without looking at the MRI which level do you suspect has developed neural foraminal stenosis?
L5-S1.
L4
Hoffmans, check for ataxic gait, check manual dexterity
With resisted bicep flexion, you note the patient can resist you but after a second or two you start to overcome the patient's strength. What grade from 1-5 would you assign for biceps muscle strength for this patient?
4/5. Patient can resist but not completely which would be 5/5
Patient has pain running along the right lateral thigh. Which dermatome is this?
L5
The achilles reflex checks which nerve root level?
S1
Please describe a positive Spurling test
Reproduction of radicular symptoms with cervical extension, side bending, and lateral rotation toward the symptomatic side, with gentle downward force applied.
Can you have a positive Spurling test if there are no radicular symptoms to begin with?
You notice your patient has right ankle dorsiflexion weakness. Which nerve root do you suspect is injured?
L5 nerve root
C7
A patient with back pain has brisk reflexes within the patella and achilles bilaterally with normal reflexes within the triceps and biceps. Which imaging do you want to order?
How do you perform a hoffman's test and what does a positive test mean?
extend the wrist and middle finger and flick down on the distal tip of the finger. If you see the thumb or other fingers contract it indicates a positive test and possible upper motor neuron injury (brain or spinal cord). If symmetric and similar to the contralateral side can also just be indicative of general hyperreflexia
You notice your patient has weakness with resisted bicep flexion. Which nerve root do you suspect is compromised?
C6 (C5 would also be an acceptable answer although biceps is predominantly C6)
Patient has numbness along the posterior thigh and calf. Which dermatome is this?
S1
What does clonus assess for?
upper motor neuron injury.
Patient with low back pain has a positive babinski test. What could you potentially anticipate seeing on the MRI L Spine?
upper motor neuron injury (brain/spinal cord).
myelomalacia or cord signal changes within spinal cord.
Your patient has weakness with elbow extension. Without looking at the MRI, and assuming conservative measures have failed, which level will you likely order for your cervical TFESI?
C6-7 (to target the C7 nerve root. Triceps)
You have a patient with numbness of the first three digits of the right hand. Which cervical TFESI level do you anticipate pursuing, even before review of the mri?
C5-6 TFESI
A patient has severe right L4-5 neural foraminal stenosis on MRI. Which reflex would you pay particular attention to and what would you expect to find (increased or decreased DTR)?
patellar reflex (L4). Decreased DTR. Lower motor neuron injury. Any injury to the nerve root within neural foramen or below results in lower motor neuron findings or hyporeflexia.
***SPECIAL QUESTION*** Please list as many components of a neurologic exam as you can and send to me through teams. Whichever team lists the most will win these points.
If there is a tie we will ask another question
sensation, strength, reflexes, gait, special tests. (Technically mental status and cranial nerves too)