Spinal Cord Injury
What is the bowel regimen for UMN?
3 Colace, 2 Senna, 1 suppository + DRS
When performing the INSCI exam, what muscle is tested when testing T1 Myotome?
Abductor Digiti Minimi (small finger abductor)
What is the expected finding in sensory nerve conduction study in patients with radiculopathy, and why?
Normal, lesion is proximal to the DRG
Serratus anterior
Long thoracic nerve
Medial scapular winging
Describe set up of one carpal tunnel comparison study
median-ulnar
median-radial
ulnar-medial palmar
How does SCI affect female vs male fertility
Female: once menses return, fertility is not affected
Male: Impaired fertility due to ejaculatory dysfunction and poor seme quality
What is the most common incomplete SCI syndrome? Describe the clinical picture
Central Cord Syndrome
UE Weakness > LE Weakness
Recovery: Generally LE's recover first and to a greater extent followed by bladder function, then proximal UE, and finally intrinsic hand muscles
Under the Awaji criteria, what are the four body regions that should be evaluated with needle EMG when working up a patient for suspected ALS
Flexor Pollicus Longus
anterior interosseous nerve (AIN)
Symptoms of baclofen withdrawal (at least 3)
Agitation, Pruritis, visual/auditory hallucinations, seizures, hyperreflexia, rebound spasticity
Above what level would you expect Autonomic Dysreflexia? What is the mechanism?
Levels above T6
Syndrome of massive imbalanced reflex sympathetic discharge in patinets with SCI above the splanchnic outflow (T5-L2)
Noxious Stimuli below the level of the lesion > causes too much sympathetic outflow and loss of descending control
What is the potential functional outcomes for a person with complete C7 Tetraplegia with regards to
1. Feeding
2. Grooming
3. UE Dressing
4. LE dressing
5. Transfers
(i.e. Max assist, mod assist, min, mod ind, CGA, supervision)
1. Mod Independent
2. Mod Independent
3. Independent
4. Mod-Ind/CGA
5. Independent with or without board for level surfaces
If a patient presents with weakness in foot inversion and big toe extension, testing this specific muscle can definitively differentiate an L5 radiculopathy from a common peroneal (fibular) mononeuropathy.
Tibialis posterior
Supinator
PIN
Most common cause of rehospitalization in SCI pateint
GU disorders / UTI
The two most common causes of nontraumaticspinal cord injury requiring acute inpatientrehabilitation are?
Spinal stenosis with myelopathy and spinal cord tumors
During the ISNCSCI/ASIA motor examination, which muscle is tested to assess the C6 myotome?
(ECRL), (ECRB)
Patient evaluated for suspected CTS, EDX reveals giant median CMAP when stimulated at the elbow compared to the wrist, while stimulating the ulnar nerve at the elbow yields a tiny or absent response, confirming this variant.
Martin-Gruber Anastomosis
Martin-Gruber: Crossover in the forearm (Median to Ulnar). Affects elbow vs. wrist amplitudes.
Riche-Cannieu : Crossover in the palm (Ulnar to Median).
Tensor Fascia Latae
Superior Gluteal Nerve
Stable T4 paraplegia from a MVA ten years ago presents with a new onset of burning pain in his hands and a loss of sensation that has climbed from his chest up to his shoulders. What is the most likely diagnosis and gold standard imaging modality ?
Syringomyelia and MRI
A diver strikes the top of his head in shallow water.
Which cervical fracture is most likely?
Jefferson
A patient has:
What is the motor level?
A. C5
B. C6
C. C7
D. C8
Answer: A. C5
What is the most proximal muscle innervated by the tibial nerve
semitendinosus
Adductor Magnus (Dual Innervated)
Obturator
Tibial
What is the expected finding on Repetitive Nerve Stimulation in Myasthenia gravis vs Lambert Eaton?
In MG, RNS shows a decremental response (worsening CMAP with repeated stimulation) due to postsynaptic acetylcholine receptor blockade
In LEMS, the opposite pattern occurs because the problem is presynaptic (reduced initial release, but improved release with stimulation