Neurological Exams for Neck and Back Pain: Nerve Deficits
Muscle Strength and Tone
Measuring muscle strength and tone is another way to determine if nerve deficit exists. To evaluate muscle strength the patient may be asked to step up on a stool, stand on their heels then the toes, hop in place, perform knee bends, and grip an item in each hand. Muscle strength is graded and recorded in the patient’s chart.
|1||Trace of muscle contraction|
|2||Active movement without gravity|
|3||Active movement against gravity|
|4||Active movement against gravity/resistance|
The physician tests muscle tone by passively flexing and extending the arms and legs. Normal muscle tone elicits slight resistance to passive motion. Other movements test for proximal (trunk) and distal (distant) weakness. Muscle symmetry is also observed.
If warranted, the spine specialist may order specific neurological studies such as a Nerve Conduction Study (NCS) or Electromyogram (EMG). These tests measure nerve performance.
MRI and/or CT scans of the spine can be ordered to help the spine specialist make the correct diagnosis.
The neurological examination, along with a detailed mechanical examination (movement of the arms, legs, and trunk), can greatly help the physician in making the correct diagnosis. The findings of the examination are then correlated with the history of the patient’s ailment and diagnostic studies to make the correct diagnosis. Once the diagnosis is made, appropriate treatment is initiated. This usually consists of non-surgical measures but if those fail, or occasionally initially, surgical intervention is considered.