Alhamdulillah! All praises be to Allah. Many thanks to Him and I can never thank You enough.
Finally, I'm done with Orthopedics & Traumatology! For me, 2 weeks on the ground of 'mental cruelty' really test my patient. And yesterday, after the final exam with two Orthopedics specialist, I passed it! Alhamdulillah..
Though how bad I felt to repeat in this department for 2 weeks, deep inside my heart I knew that it is good for me indeed. Since I left it for almost 1 year, I could say that I have forgot fro almost 90% of all the knowledge that I gained from it last year. A bit exaggerating. But that really happen. And I thank Allah for giving me what's the best for me. The things that I really need, though how much I don’t like it.
I just enjoyed when I realized that I gain something useful for me while repeating this department. All the knowledge are useful, but you know something? I managed to understand something that should be understand during posting in Neurology department. It's about the spinal cord! The berbelit2 tracts : spinothalamic tract, corticospinal tract, bla2.. And the dermatomes that stressed me enough on how to memorize it.. Well, now I just understand it and actually we don’t have to memorize it though if really understand them. I owe millions of thank you to my Orthopedics resident who taught me the mnemonics to remember it. And I want to recall them here, while sharing it with you :)
In any disease affecting the spinal cord, from any causes be it due to trauma ( especially in high-energy injury ), infection, neoplasm (primary or metastatic), degenerative disease, bone metabolic disease and etc, the doctor need to know the level of dermatome that was affected.. For evaluation and management, and plus, when we gonna ask for radiology examination, the CT-scan and the MRI, it is better if we mention the level of spinal cord that we want to see. So that it would be easy for the radiologist to perform their task, and good for us to evaluate it and thus helping us in managing our patients.
So in spinal cord examination, there are MOTORIC, SENSORIC, and REFLEXES examination that must be perform in order to know the level of dermatome that is affected.
Dermatomes.. [Dermatome: is an area of skin, that is mainly supplied by a single spinal nerve. There are eight cervical nerves, C1-C8 (but C1 is not related to dermatome); twelve thoracic nerves T1-T12; five lumbar nerves L1-L5; and five sacral nerves S1-S5. Each of these nerves relays sensation (including pain) from a particular region of skin to the brain.)
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| Picture 1 |
*it might hard to understand by just read and look at it, need explanation still. But never mind, at least for me..hehe. Hope I can remember it when I look at this :) *
For MOTORIC, just remember:
- C2 is the face and the head (front and back = anterior and posterior).
- C3 is the neck
- C4 is around the clavicle and sternum
- C5, C6, C7, C8, T1 (C5-T1) is for the upper extremities. The mnemonic for them, just remember the basket ball game.. Let's visualize our mind to the sequence of actions when the player try to shoot the ball into the basket
- C5 is shoulder abduction. (he up the shoulder to grab the ball)
- C6 is arm flexion and wrist extension. (grab the ball)
- C7 is arm extension, wrist flexion, and finger extension. (shoot the ball)
- C8 is finger flexion. (after shoot the ball, he hold the fingers at the basket)
- T1 is finger abduction and adduction.
*easy and interesting, isn't it? * ^_~
For motoric of lower extremities, the mnemonic is the football game. Visualize the sequence of action when the player wanna shoot the ball. *not so exact but kind of football laa..huhu*
- T12-L2: hip flexion
- L3: knee
- L4: dorsi flexion (foot flex upward) + foot inversion
- L5: great toe flexion
- S1: plantar flexion (foot flex downward) + eversion
For SENSORIC:
- C5 : the badge area (lateral shoulder)
- T4: the papillae (so T1-T3 automatically between C4 and T4 - see picture 1)
- T7: xiphoid process (anterior), or at tip of scapular (posterior)
- T10: umbilicus
- T12-L1: inguinal
For REFLEX:
- C5: biceps reflex
- C6: triceps reflex
- C7: brachioradial reflex
- L3: Knee Pee Reflex (KPR)
- S1: Archilles tendo reflex
- S1, S2, S3: bulbocavernous reflex
Okay that's the simple physical examination for spinal cord injury.
^^,
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