After the primary survey has been performed and any immediately life-threatening conditions have been addressed, a complete neurologic examination should be performed. The motor exam should assess the strength of all extremities. Any deficits should be localized to a nerve root level ( Tabje... 2.64-.1). The sensory exam should ensure that sensation is present in all extremities. Sensory innervation follows the dermatome pattern. The loss of sensation at and below a given dermatome can localize the level of the injury (Fig 2.6.4:1). Priapism should be considered as evidence of a spinal cord injury. Rectal examination may reveal decreased tone due to spinal cord injury. Prognosis can be difficult to determine in the early stages of a spinal cord injury owing to the temporary condition of spinal shock. Spinal shock as defined here is different than the spinal neurogenic shock discussed in Chap, 31. Spinal shock, a condition seen frequently in the first 24 h after injury, is defined by a complete loss of segmental cord reflexes in addition to paralysis. Only after the spinal shock has remitted can any definitive prognosis be given. Resolution of spinal shock is heralded by return of segmental reflexes (bulbocarvernosus in males).
TABLE 264-1 Motor Examination
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