see also: [[Neuro - lower limb]] and [[Neuro - upper limb]]. [[paediatric c-spine]], [[Dermatomes#Spinal exam|Spinal exam]] related: [[Neck and spine trauma|c-spine trauma]], [[Cervical spine trauma radiology|C-spine radiology]] see practice OSCE: [RMH 2022 - 5 C spine](x-devonthink-item://BB2F581A-E9FF-49D7-97D7-874AE25B98D8) > [!key points] > 1. risk assessment > 2. immobilise C spine appropriately > 3. MOI, "distracting injuries" > 4. log roll > 5. focused neurological examination > 6. appropriate management and disposition # Spinal cord clinical clearance ![[Cervical spine trauma radiology#NEXUS]] ![[Neck and spine trauma#Canadian c-spine rule]] # exam See [[Neuro - upper limb]] and [[Neuro - lower limb]] and [[Dermatomes#Spinal exam]] for exam -- be efficient/focused PR exam during log-roll for S3-S5 ## Important sensory levels | level | sensation | | ----- | --------------------------------------------- | | C5 | outer shoulder tip | | C7 | middle finger | | T3 | Axilla | | T8 | rib margin | | T10 | umbilicus | | T12 | pubic symphysis | | L3 | knee | | L5 | outer aspect of tibia to inner aspect of foot | | S1 | little toe | | S3-S5 | peri-anal | ## important motor and reflex changes See also [[Dermatomes#Reflexes]] | level | motor and reflexes | | --------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | C5 | - lower motor neurone weakness and wasting of rhomboids, deltoids, biceps, brachioradialis<br>- UMN signs affecting rest of upper and all lower limbs<br>- biceps jerk is lost | | C8 | - LMN weakness and wasting of intrinsic muscles of hand<br>- UMN signs in lower limbs | | T10 - T11 | - loss of lower abdominal reflexes and upward displacement of umbilicus<br>- UMN signs in lower limbs | | L1 | - cremasteric reflex lost (normal abdominal reflexes)<br>- UMN signs in lower limbs | | L4 | - LMN weakness and wastting of quadriceps<br>- knee jerk lost<br>- ankle jerks may be hyperreflexic with extensor plantar response (upgoing toes), but more often the whole conus is involved, causing a lower motor neurone lesion | | L5-S1 | - LMN weakness of knee flexion and hip extension (s1) and abduction (L5)<br>- knee jerks present<br>- no ankle jerks or plantar responess<br>- anal reflex present | | S3-S4 | - no anal reflex<br>- saddle sensory loss<br>- normal lower limbs | ![[Pasted image 20250103102122.png]] # management considerations - CT or admit for MRI if focal neuro deficit - avoid secondary injury - MAP > 80 , BP > 100 systolic - avoid hypoxia - analgesia