89 Tetraplegia
Salient features
Examination
• Increased or decreased tone in both lower limbs
• Wasted hands (cervical spondylosis, motor neuron disease or syringomyelia).
• Remember to check the sensory level and examine the spine.
• Tell the examiner that you would like to do the following:
• Try to localize the level of lesion using the following:
• Spasticity of the lower limbs with flaccid weakness of some muscles of the upper limb: lesion of cervical cord enlargement (C5–T2)
• Deep tendon reflexes: an absent biceps jerk with a brisk supinator jerk (inversion of the supinator jerk) or an absent biceps and supinator with a brisk triceps jerk localizes the lesion to C5–6
• Radicular pain: useful early in the disease; with time becomes diffuse and ceases to have localizing value
Note: Be prepared to discuss the Frankel classification (below).
