Spinal Levels—Motor, Sensory, and Reflex Exam

What have you, fair clinician, to test when you are trying to sort out spinal disease?

The HISTORY, of course. This should guide your examination towards pertinent positive and negative findings But wait, there's more

The physical exam findings are pretty important in localizing the level of the disease With a good exam, one can localize disease to within a millimeter in the spinal cord No, it's not magic, nor is it Chairman's Necromancy It is the application of knowledge that you already have, but which we will help you to reorganize into clinically useful packets

By the way, you may have noticed that 3rd and 4th years teach some new info, but a lot of old info too. The key is to take all this info and divvy it up into useful chunks that you can get to when you need them It's the difference between a pile of books and a library Between a sheet of notes and a symphony Between but we digress

And now for a table of spinal levels with their clinical correlates and brain teasers...

Spinal level	Motor	Sensory	Reflex	Related Stuff
C 2		pinna of the ear
C 3,4,5	phrenic N to diaphragm			in total and complete C-spine injury, how do people breathe?
C 4		strip 2 inches above nipple line		ER Quiz 1
C 5	deltoid	skin over deltoid	naah	at what angle of abduction does the deltoid begin to work?
C6	biceps	thumb	biceps	what peripheral nerve entrapment can mimic a C 6 radiculopathy?
C 7	triceps	middle finger (easy to remember)	triceps	in a C spine Xray, where do you look for a C7 radiculopathy?
C 8 - T1	intrinsic hand M's	ring and little fingers		what peripheral nerve entrapment can mimic a C8-T1 radiculopathy?
T 4		2 inches above nipple line		ER Quiz 2
T 6		nipple line
T 8		costal margin		what common condition can a right T 8 radiculopathy mimic?
T 10		umbilicus
T12 - L1		inguinal crease	cremasteric	ICU Quiz 1
L2 - L3	hip flexors	patch just above knee
L 4	quadriceps	mesial thigh and calf	knee jerk	what diabetic mononeuropathy mimics L4 radiculopathy?
L 5	extensor hallucis longus, foot dorsiflexors	web space between great and 2nd toe	nope major design oversight	what do their shoes look like?
S 1	foot plantar flexors, gastrocs	lateral and plantar foot	ankle jerk	in an LS spine Xray, where do you look for an S1 radiculopathy?
S2 - S5	voluntary contraction of sphincters	perineal area	bulbocavernosus, anal wink	in males, to test lower sacral sensation, do you pick the penis or the scrotum?

Had enough? Don't worry, you just learned the keyboard. Now on to making music.