[(Orthopaedic Neurology: A Diagnostic Guide to Neurologic by Stanley Hoppenfeld

By Stanley Hoppenfeld

...a vintage monograph that serves as a diagnostic advisor to neurologic degrees for citizens in either orthopedics and neurology.

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1-37). If the disc protrudes but does not herniate, pain may be referred to the midline of the back in the area of the superior medial portions of the scapulae (Fig. 1-38). Lateral protrusion may send pain along the spinous border of the scapula (most commonly to the superior medial angles), with radiation of pain down the arm, but usually without neurologic findings. Occasionally, there may be inconsistent findings of neurologic level involvement during the examination. Sometimes the brachial plexus, which usually includes the nerve roots C5 to Tl, will begin a level higher (pre-fixed) or a level lower (post-fixed), causing variations in the segmental innervation of the muscles; the findings will reflect this inconsistency in the innervation of the upper extremity.

Differentiation between generalized soft tissue injury without neurologic involvement and injury with neurologic involvement can be made by testing the integrity of the neurologic levels innervating the upper extremities. With each patient visit, neurologic testing must be repeated, since an originally quiescent lesion may later clinically manifest itself. Note that the converse is also true: patients who are hospitalized for treatment of neurologic problems may show improved muscle strength, return of a reflex, or return of normal sensation to the involved dermatome.

MH~SORS . SENSATION FIG. 1-42. A herniated disc between vertebrae C7 and Tl involves the C8 nerve root. J . ••.. ·~'l ~ FIG. 1-43. A herniated disc between vertebrae TI and T2 involves the T1 nerve root. A herniated disc in this area is unusual. Clinical Application of Neurologic Levels 37 FlO. 1-44. Myelogram: herniated disc at C5-C6. Table 1-1 summarizes the areas of neurologic level testing. In addition, it demonstrates the clinical application of neurologic level testing to pathology in the cervical spine, especially with regard to the evaluation of herniated discs.

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