Muscular Assessment:

The evaluation of muscular performance is an important part of the evaluation of the patient with nerve compromise secondary to radiculopathy or myelopathy.  A variety of physical parameters can be measured.  One of the most commonly measured attributes of muscle is its strength.  Other quantitative categories of measurement include power, endurance, muscle contraction (activation) patterns, and torque.  The most practical parameters to measure are strength, endurance, and muscle contraction patterns. 

Strength is defined as the ability of a group of muscles to exert force.  Force is an essential component of daily function.  Strength testing falls into one of two primary categories: static or dynamic.  Static testing refers to evaluation of force without limb or joint movement. 

Dynamic testing requires movement of the joint and muscle against resistance.  Dynamic testing can be further subcategorized into isotonic and isokinetic testing.  Isotonic testing refers to evaluation with fixed resistance and variable velocity.  Isokinetic testing is used to measure an individual’s ability to apply force at a constant rate of speed.  Isotonic testing comes closest to stimulating normal activities, although isokinetic testing provides a more accurate method of measuring change.  The assessment of muscular strength can be placed into three primary categories:

1.         Isolated.

2.         Regional.

3.         Kinetic chain.

Assessment of isolated muscle performance can be very useful in the assessment of spinal nerve compromise.

Physical Examination:

The physical examination of the spine should be an extension of an adequate history and general physical examination.  Examination of the spine involves but is not limited to spinal palpation, biomechanical assessment, assessment of extremity strength, coordination, reflexes and sensation.  Orthopedic tests are performed to assessment bony, muscular and ligamentous integrity of the spine and extremities.  The examination should include functional assessment such as observation of gait (walking patterns) and observation of the performance of specific extremity tasks requiring neurological control from the spine.  Spinal range of motion may be assessed.  A follow- up physical examination of the spine typically involves limited re-assessment of areas and tests previously found to be abnormal.