Question

A 74-year-old retired male was admitted to hospital s/p fall backward

while mowing the lawn. At time of hospital admission pt presented with paralysis of both arms and uncoordinated movement of legs. Pt's mental status was normal. Vision and hearing were intact. Upon examination, pt was not able to discriminate temperature or light touch of BUEs. Initially, pt was not able to stand or sit up at the edge of the bed. Positive Babinski's sign.
Prior to arrival at this SNF, pt spent 6 weeks in acute rehab and was sent to another SNF for 1 week. By 3 months pt reports constant tingling in hands and pressure to front of thighs. Pt can feed himself with adaptive equipment and gets around the facility in his wheelchair. 



-What does positive Babinski's sign mean? Also, when is it considered normal?
- Why does Mr. Gibson have constant tingling in his hands? In answering this question, please name this symptom and describe what part of the spinal cord must be damaged for him to have this symptom
- Let's say Mr. Gibson's has only trace strength at the C6 and C7a. What UE muscles are fully innervated for Mr. Gibson and should have good strength?
b. Which muscles are associated with the C 6 and C7 myotomes?

Answer & Explanation
Verified Solved by verified expert

1.normal:The Babinski reflex occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot. The other toes fan out. This reflex is normal in children up to 2 years old

Not normal: In adults or children over 2 years old, a positive Babinski sign happens when the big toe bends up and back to the top of the foot and the other toes fan out. This can mean that you may have an underlying nervous system or brain condition that's causing your reflexes to react abnormally

 

Source:https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.healthline.com/health/babinski-sign%23:~:text%3DIn%2520adults%2520or%2520children%2520over,your%2520reflexes%2520to%2520react%2520abnormally.&ved=2ahUKEwi01cKH5u_uAhXXyYsBHYlPC9sQFjAGegQIBhAE&usg=AOvVaw2nEokInxORzdKl6rtprath

 

2. PARESTHESIA

-refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body

-often a symptom of an underlying neurological disease or traumatic nerve damage.

-Causes: disorders affecting the central nervous system, such as stroke and transient ischemic attacks (mini-strokes), multiple sclerosis, transverse myelitis, and encephalitis. A tumor or vascular lesion pressed up against the brain or spinal cord can also cause paresthesia. Nerve entrapment syndromes, such as carpal tunnel syndrome, can damage peripheral nerves and cause paresthesia accompanied by pain.

Source:https://www.ninds.nih.gov/disorders/all-disorders/paresthesia-information-page#:~:text=%2C%20transv...-,Paresthesia%20refers%20to%20a%20burning%20or%20prickling%20sensation%20that%20is,%2C%20skin%20crawling%2C%20or%20itching.

 

- part of the spine : Thoracic spine which affects the torso, parts of the arms (T1 thru T12)

 

Step-by-step explanation

3. C6 injury

  • Nerves affect wrist extension.
  • Paralysis in hands, trunk and legs, typically
  • Should be able to bend wrists back
  • Can speak and use diaphragm, but breathing will be weakened
  • Can move in and out of wheelchair and bed with assistive equipment
  • May also be able to drive an adapted vehicle
  • Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment
  • C7 injury
    • Nerves control elbow extension and some finger extension.
    • Most can straighten their arm and have normal movement of their shoulders.
    • Can do most activities of daily living by themselves, but may need assistance with more difficult tasks
    • May also be able to drive an adapted vehicle
    • Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment

 

A. UE muscles (please check photo attached for complete list)

16531620

https://neuromuscular.wustl.edu/nanatomy/cervanat.htm

 

B.

C6: Wrist Extension

C7: elbow extension/wrist flexion/finger extension

Image transcriptions
9:59 MF . . . Call Home, Search, Index, Links, Pathology, Molecules, Syndromes, Muscle, NMJ, Nerve, Spinal, Ataxia, Antibody & Biopsy, Patient Info Upper Extremity Muscles & Innervation Roots Nerves Also see Root lesions Axillary Radial Arm weakness at disease onset Dorsal scapular Posterior interosseus Brachial plexus Brachial plexus Long thoracic Superficial radial Proximal arm weakness Hereditary Median Spinal accessory Thoracic outlet Acquired Anterior interosseus Suprascapular Martin-Gruber Ulnar Legs Musculocutaneous Root, Brachial plexus and Nerve components http://www.wheelessonline.com/ortho/rhomboids Roots1 Trunks Cords Muscle Nerve C4 C5 C6 C7 C8 T1 Sup Med Inf Lat Post Med Trapezius Spinal accessory + Rhomboid Dorsal scapular + Supraspinatus Suprascapular + Infraspinatus Suprascapular + Deltoid Axillary + Teres minor Axillary. 1+ Biceps Musculocutaneous + Brachialis Musculocutaneous + Brachioradialis Radial + + Pectoralis major upper Lateral Pectoral + + + Pectoralis minor Medial Pectoral + + Serratus anterior Long thoracic + + .+ Supinator Radial + Pronator teres Median + + Muscle Nerve C4 C5 C6 C7 C8 T1 Sup Med Inf Lat Post Med Latissimus dorsi Thoracodorsal + + Teres major Subscapular (Lower) + Extensor digitorum Radial + Anconeus Radial + + + Flexor carpi radialis Median + + Pronator quadratus Anterior Interosseus + + + Flexor digitorum profundus Anterior Interosseus + + Ulnar Triceps Radial + + + Extensor indicis Radial + + + Flexor carpi ulnaris Ulnar + + Dorsal interosseus I Ulnar + + Abductor pollicis brevis Median + + Paraspinal Cervical + + + + Muscle Nerve C4 C5 06 C7 C8 T1 Sup Med Inf Lat Post Med Sup = Superior; Inf = Inferior; Med = Medial; Lat = Lateral; Post = Posterior Muscles innervated by 2 nerves . Flexor digitorum profundus: Anterior interosseus & Ulnar nerves