F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
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triceps has its full power. However, there is partial paralysis of the adductor pollicis,
interossei and lumbricals. The abductor pollicis brevis is still paralysed. Foerster has
always emphasized that this muscle is the only monosegmentally innervated muscle of
the upper limbs and my own experience is in accordance with his view in the great
majority of cases. C8 may also take part in its innervation in individual cases.
There is also a nuclear Horner's syndrome and anhidrosis in face, neck and arm
(Fig. no). The triceps reflex is present. The sensory loss in the upper limbs involves the
medial side of the forearm and distal part of the upper arm. Figs. 1153 and b demonstrate
the sensory loss of touch, pain and temperature sensibility following resection of the
posterior root of Ti.
TI-T5 SEGMENTS
While in transverse lesions at Ti the respiration is still of some diaphragmatic type, the
inspiratory function of the lungs increases the lower the level of the upper thoracic
lesion, commensurate with the increase of function of the intercostal muscles. Therefore,
in lesions at TS the inspiratory function of the lung is already very strong. Moreover, the
extension of the upper thoracic spine is also much stronger as compared with that of
higher thoracic and cervical lesions.
The common symptom of complete transverse lesions above T5, especially in Ti
and cervical lesions, is the loss or impairment of the vasomotor control resulting in
postural hypotension leading to syncope when raising the patient from the horizontal
to the upright position.
The sensory loss in T2 lesions extends up the whole body to the inner side of the
upper arm, in T3 lesions it includes the axilla, in T5 lesions the nipples.
T6-TI2 SEGMENTS
In complete transverse lesions from T6 downwards the individual segments of the rectus
abdominis and of the lateral abdominal muscles are spared. In lesions T6-T9, the supra-
umbilical segments of the rectus abdominis are functioning and on voluntary action the
umbilicus is pulled upwards. A simple test to provoke this action is the so-called 'kit-test5,
whereby with the sudden forced expiration on calling the word 'kit' the umbilicus is
pulled upwards in these lesions. In transverse lesions below Tio the infra-umbilical
segments of the rectus are acting and the upward pull of the umbilicus disappears, but the
distal lateral parts of the abdomen are forced out on abdominal pressure on account of
the paralysis of the lower fibres of obliquus internus and transversalis abdominis. In
lesions below T12 all abdominal muscles are functioning with full power.
All abdominal reflexes are abolished in T6 lesions, while in lesions at and below Tio
the upper and middle abdominal reflexes are present. In Ti2 lesions, all abdominal reflexes
are present, but the cremasteric reflexes are absent. Knee and ankle jerks become exag
gerated and, as in all transverse lesions above the thoraco-lumbar junction, the paralysis
of the lower limbs is of spastic type.
The sensory loss in T6 lesions extends to the xiphoid, in Ty/8 to the lower costal
margin, in Tio to the umbilicus and in T12 to the groin.
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