Printable View
Hiya, hope you guys can clarify this for me.... a patient has neck pain and experiencing bilateral paraesthesia in their legs.....what could be the cause of this? Would i carry out tests like babinski and clonus? are there any other tests that would need to be carried out to test the integrity of the CNS?
Thanks if you can help me :)
In a word....YES.
You need to do a full assessment to know if these two symptoms are related, to guide you with treatment and to tell you if you need to be referring to someone else.
Do your cervical and lumbar scans including neuro testing (reflexes (for both nerve roots and CNS/upper motor neurons), key muscles (myotomes), dermatomes).
Any medical testing done prior to you seeing him in physio? Any imaging done??
Yes , I agree you need to perform full assessment and examination ,however you should have the skill / competency to differenate between upper motor neurn lesion and lower motor neuron lesion when you have doubts as youu seem have with this patient .
As well , ask your patient if the symptoms ( numbness) in both lower limbs are the same degree or one more than the other .
In few cases it is difficult to differnate . Also ,in some cases of severe Central Nervous System sensitivity numbness , pain and tingling could be tied together in upper and lower quarters .
cheers
Emad
Hi, If the bilateral paraesthesia in the legs is linked to the neck, it could be indicative of cord compression. Cord signs are bilateral paraesthesia in hands/feet and or gait disturbance. It is important to assess upper and lower limb dermatomes myotomes and reflexes. Babinski if upgoing would implicate an UMN problem.
I would also ask about dizziness, dysphagia, dysarthria, diplopia, drop attacks or any facial numbness which may point towards an underlying upper cervical instability, especially following a whiplash injury or if there is any history of RA.
If you suspect cord compression it is important to refer on in a timely manner.
For a neck pain with that presentation, you should perform a neurological examination for his upper limb and lower limbs. Test his upper limbs and lower limbs for upper motor neuron and lower motor neuron signs by testing his muscle tone, hypertrophy or hypotrophy, deep tendon reflexes, ankle clonus, plantar response, superficial reflexes. muscle power, sensation to pin prick or light touch, Neck regidity, bladder and bowel control. Please, also check the local mobility testing in the neck and lumbar or thoracic spine to see any local signs or restrictions. There may be also a coexisting problem in the lumbar spine. Brief me about your clinical examination. Let us see what is there in the clinical testing.
This potentially shows some huge red flags! what's the onset pattern? frequency/severity of symptoms? other symptoms? etc.
As well as the other advice already listed, ask about continence too (either loss of or difficulties). Personally i'd do a basic neuro exam for documentation and inclusion in a specilist referral letter but i would definitely refer for medical assessment to clear the really nasty stuff (ie. refer back to the GP for referral to a neurologist if needed).
As physios we have good ability to examine the Msk system and neuro function but it's not our place to diagnose UMN lesions, or major pathology without specialist investigation and advice. Appropriate "special questions" should highlight red flags to you which warrant further investigation and clearing before physio should go ahead. if it turns out to be nothing sinister then physio might be a great pathway in the end.