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
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Positive Babinski's sign causes strange response of the body reflexes. 

Step-by-step explanation

1. In grown-ups or youngsters more than 2 years of age, a positive Babinski sign happens when the enormous toe twists up and back to the highest point of the foot and different toes fan out. This can imply that you may have a fundamental sensory system or mind condition that is causing your reflexes to respond strangely.

Evoked by a dull boost to the underside of the foot, the ordinary grown-up Plantar Reflex presents as a descending flexion of the toes toward the wellspring of the improvement. Babinski's sign is seen when the Hallux (huge toe) displays dorsal augmentation because of a similar plantar incitement.

2.  The part of the spinal cord affected is C7 nerve root. C7 is the nerve "root" that leaves the spinal string over the seventh vertebra in the neck. It goes into the brachial plexus and in the end turns into the nerves that feed muscles that fix the elbow, twist the wrist, and fix the fingers. It likewise gives sensation around the center finger in the hand. This condition is called finger numbness. 

3. a.  C7 will be associated with the strength of triceps muscle and the C6 with Subclavius, Supraspinatus, Biceps, Brachii, Brachialis Infraspinatus and Deltoid.

b. The C6 innervates the extension of the wrist myotome and C7 innervates extension of the elbow and finger, flexion of the wrist. The nerve root of C7 runs between vertebrae C6 and C7. Motor function includes: full shoulder movement (rotation, adduction and abduction) strong scapular stability. elbow extension - tricep (ability to straighten bentarm)