Spinal cord injury

• Insult to the spinal cord resulting in a change, either temporary or permanent, in its normal motor, sensory, or autonomic function.
• Tetraplegia or paraplegia.
• Mechanism: destruction from trauma/ compression/ ischaemia

Spinal shock
Neurogenic shock
Autonomic dysreflexia
Muscle strength is graded using the following Medical Research Council (MRC) scale of 0-5:

• 5 - Normal power
• 4+ - Submaximal movement against resistance
• 4 - Moderate movement against resistance
• 4- - Slight movement against resistance
• 3 - Movement against gravity but not against resistance
• 2 - Movement with gravity eliminated
• 1 - Flicker of movement
• 0 - No movement

Muscle strength always should be graded according to the maximum strength attained, no matter how briefly that strength is maintained during the examination. The muscles are tested with the patient supine.

The following key muscles are tested in patients with SCI, and the corresponding level of injury is indicated:

• C5 - Elbow flexors (biceps, brachialis)
• C6 - Wrist extensors (extensor carpi radialis longus and brevis)
• C7 - Elbow extensors (triceps)
• C8 - Finger flexors (flexor digitorum profundus) to the middle finger
• T1 - Small finger abductors (abductor digiti minimi)
• L2 - Hip flexors (iliopsoas)
• L3 - Knee extensors (quadriceps)
• L4 - Ankle dorsiflexors (tibialis anterior)
• L5 - Long toe extensors (extensors hallucis longus)
• S1 - Ankle plantar flexors (gastrocnemius, soleus)

Sensory testing is performed at the following levels:

• C2 - Occipital protuberance
• C3 - Supraclavicular fossa
• C4 - Top of the acromioclavicular joint
• C5 - Lateral side of antecubital fossa
• C6 - Thumb
• C7 - Middle finger
• C8 - Little finger
• T1 - Medial side of antecubital fossa
• T2 - Apex of axilla
• T3 - Third intercostal space (IS)
• T4 - Fourth IS at nipple line
• T5 - Fifth IS (midway between T4 and T6)
• T6 - Sixth IS at the level of the xiphisternum
• T7 - Seventh IS (midway between T6 and T8)
• T8 - Eighth IS (midway between T6 and T10)
• T9 - Ninth IS (midway between T8 and T10)
• T10 - 10th IS or umbilicus
• T11 - 11th IS (midway between T10 and T12)
• T12 - Midpoint of inguinal ligament
• L1 - Half the distance between T12 and L2
• L2 - Midanterior thigh
• L3 - Medial femoral condyle
• L4 - Medial malleolus
• L5 - Dorsum of the foot at third metatarsophalangeal joint
• S1 - Lateral heel
• S2 - Popliteal fossa in the midline
• S3 - Ischial tuberosity
• S4-5 - Perianal area (taken as 1 level)

Sensory scoring is for light touch and pinprick, as follows:0 - Absent/ 1 - Impaired or hyperesthesia/ 2 - Intact

A score of zero is given if the patient cannot differentiate between the point of a sharp pin and the dull edge.