About us Medical services Our staff For Medical Professionals Contact Us Medical services Informational Material Neurological Examination Neurological Examination The medical professional dealing with diseases of the spine, shall he be an orthopedist, traumatologist or rheumatologist, has to be familiar with and routinely apply the fundamentals of a neurological examination. The Patient’s medical history provides us with information regarding the nature of the clinical pictures and spinal diseases that caused the neurological deficit associated with certain spinal disorders. The following are some of the more important questions in our search for clues and often of diagnostic value when taking the Patient’s medical history: • Do you have a problem with walking and keeping your balance? • Do you feel weakness in the upper or lower limbs? • Can you pinpoint an area of your body with sensory deficit or numbness? • Do you experience spontaneous muscle twitching? • Have you experienced cramping in your limbs and/or fingers? • Do have difficulty in controlling (holding or starting) your bowels and/or urine? • Where does your pain appear and spread to? The physical examination begins with analyzing the way you walk, its rhythm, speed, continuity, coordination and then have you standing on your heels and toes. Sensory Test During sensory testing, we compare both sides of the body. Fine touch (with finger tips or cotton wool), pain (with a pinprick) and proprioception are checked every time and two-point discrimination and temperature sensation may be added, when needed. Reflex Test The intensity of the reflexes provoked (in the upper and lower extremities, abdomen, and the medial and superior sides of the thigh) and the differences between the two sides of the body, let us know whether the damage is in the nerve root, on the periphery or, primarily, in the musculature. Examination for Muscle Strength and Tone Besides the circumference measurement, manual muscle strength assessment of the upper and lower extremities is one of the routine elements of the musculoskeletal neurological examination for judging the intensity and location of the affected nerve root. The following is the international scale for quantifying muscle strength we use: • 1 = muscle contraction but no movement • 2 = active movement with gravity eliminated • 3 = active movement against gravity only • 4 = active movement against gravity with some resistance • 5 = normal muscle strengt In polyneuropathic diagnosis, as in all musculoskeletal physical examinations, the differentiation of the central (cerebral and spinal cord) as well as peripheral nerve damage, the provocation tests and the abnormal reflex reactions help the physician set up a correct diagnosis. Many instances require electrophysiologic instrumental examinations. The electroneurographic (ENG) and electromyographic (EMG) examinations inform us regarding: • polyneuropathy, • tunnel syndrome, • central or peripheral etiology, • localization of nerve root, • dynamics of a disorder (acute or chronic nerve root damage), • muscle or nerve source. The separation of the somatosensory evoked potential test (SEP) and the motor evoked potentials (MEP) helps us determine whether the damage is central (spinal chord, brain stem or white matter), peripheral or of motor origin.