Advanced Trauma Life Support ATLS Student Course Manual 2018

132
CHAPTER 7 n Spine and Spinal Cord Trauma
table 7-1 clinical assessment of spinal cord tracts
TRACT
LOCATION IN
SPINAL CORD FUNCTION METHOD OF TESTING
Corticospinal tract
In the anterior and lateral
segments of the cord
Controls motor power on the
same side of the body
By voluntary muscle
contractions or involuntary
response to painful stimuli
Spinothalamic tract
In the anterolateral aspect of
the cord
Transmits pain and
temperature sensation from
the opposite side of the body
By pinprick
Dorsal columns
In the posteromedial aspect
of the cord
Carries position sense
(proprioception), vibration
sense, and some light-touch
sensation from the same side
of the body
By position sense in the toes
and fingers or vibration sense
using a tuning fork
table 7-2 key spinal nerve segments
and areas of innervation
C5
C6
C7
C8
T4
SPINAL NERVE
SEGMENT
INJURY
Area over the deltoid
Thumb
Middle finger
Little finger
Nipple
innervation to the region overlying the pectoralis
muscle (cervical cape). The presence of sensation in
this region may confuse examiners when they are
trying to determine the sensory level in patients with
lower cervical injuries. The key spinal nerve segments
and areas of innervation are outlined in n TABLE 7-2 and
illustrated in n FIGURE 7-2 (also see Dermatomes Guide
on MyATLS mobile app). The International Standards
for Neurological Classification of Spinal Cord Injury
worksheet, published by the American Spinal Injury
Association (ASIA), can be used to document the
motor and sensory examination. It provides detailed
information on the patient’s neurologic examination.
Details regarding how to score the motor examination
are contained within the document.
T8
T10
T12
L4
L5
S1
S3
S4 ans S5
Xiphisternum
Umbilicus
Symphysis pubis
Medial aspect of the calf
Web space between the
first and second toes
Lateral border of the foot
Ischial tuberosity area
Perianal region
Myotomes
Each segmental nerve root innervates more than one
muscle, and most muscles are innervated by more than
one root (usually two). Nevertheless, for simplicity,
certain muscles or muscle groups are identified as
representing a single spinal nerve segment. The key
myotomes are shown in n FIGURE 7-3 (also see Nerve
Myotomes Guide on MyATLS mobile app). The key
muscles should be tested for strength on both sides and
graded on a 6-point scale (0–5) from normal strength
to paralysis (see Muscle Strength Grading Guide on
MyATLS mobile app). In addition, the external anal
sphincter should be tested for voluntary contraction
by digital examination.
Early, accurate documentation of a patient’s sensation
and strength is essential, because it helps to assess
n BACK TO TABLE OF CONTENTS