Skip to main content
Symptom
dx.
Menu
Clinical Reference
Approaches
I have a symptom
Management
I know the diagnosis
Orthopedic Injuries
Fractures & dislocations
Medications
Drug reference
Calculators
Clinical calculators
OHIP Billing
Billing code lookup
Practical Skills
ECG
Interpretation guide
POCUS
Bedside ultrasound
Procedures
Step-by-step guides
Resuscitation
ACLS / PALS / NRP
Learn
Blog
Articles & updates
Deep Dive
In-depth clinical reviews
About
Our mission
Symptom
dx.
Clinical Reference
Approaches
I have a symptom
Management
I know the diagnosis
Orthopedic Injuries
Fractures & dislocations
Medications
Drug reference
Calculators
Clinical calculators
OHIP Billing
Billing code lookup
Practical Skills
ECG
Interpretation guide
POCUS
Bedside ultrasound
Procedures
Step-by-step guides
Resuscitation
ACLS / PALS / NRP
Learn
Blog
Articles & updates
Deep Dive
In-depth clinical reviews
About
Our mission
Get Started
Menu
Clinical Reference
Approaches
I have a symptom
Management
I know the diagnosis
Orthopedic Injuries
Fractures & dislocations
Medications
Drug reference
Calculators
Clinical calculators
OHIP Billing
Billing code lookup
Practical Skills
ECG
Interpretation guide
POCUS
Bedside ultrasound
Procedures
Step-by-step guides
Resuscitation
ACLS / PALS / NRP
Learn
Blog
Articles & updates
Deep Dive
In-depth clinical reviews
About
Our mission
Loading...
Cord syndromes
Shoulder & Clavicle
AC separation
Biceps tendon rupture
Clavicle fracture
Humerus proximal fracture
Rotator cuff tear
Scapular fractures
Shoulder dislocations
SLAP tear
Sternoclavicular dislocation
Arm & Elbow
Compartment syndrome (anterior, lateral, deep - superficial posterior)
Coronoid process fracture
Elbow dislocations
Epicondylar fracture
Humeral shaft fracture
Intercondylar and condylar region fracture
Olecranon fracture
Radial head fracture (Mason I-IV)
Supracondylar fracture (pediatric and adult)
Triceps tendon rupture
Forearm, Wrist & Hand
Carpal bones fractures
Carpal dislocations and ligament injuries
Distal radius and ulna fracture
Fight bite (human bite over MCP)
Finger dislocations by joint
Finger open fractures - amputations
Forearm fractures
Hand and finger tendon and ligament injuries
Hand tendon injuries
Metacarpal fractures
Nail bed injuries
Phalangeal fractures
Tuft fracture
Spine
Cervical spine fracture (C1-C7)
Cord syndromes
Sacrum and coccyx fracture
Thoracic and lumbar spine fracture
Pelvis & Hip
Acetabular fractures
Hip dislocations
Pelvis fractures
Proximal femur fractures
Thigh & Knee
Distal femur fractures
Femoral shaft fractures
Knee dislocation
Knee ligament injuries
Patellar dislocation
Patellar fracture
Patellar tendon rupture
Pes anserine bursitis
Prepatellar bursitis
Quadriceps tendon rupture
Tibial plateau fracture
Tibial spine fracture
Tibial tubercle fracture
Leg & Shin
Achilles tendon rupture
Fibular shaft fracture
Proximal fibula fracture
Stress fracture (tibia-fibula)
Tibial and Fibular shaft fracture
Tibial shaft fracture
Toddler's fracture
Ankle
Ankle dislocation
Ankle fractures
Ankle sprain
Maisonneuve fracture (proximal fibula and syndesmosis)
Peroneal tendon dislocation or tear
Peroneal tendon tear or dislocation
Subtalar dislocation
Syndesmotic injury (high ankle sprain)
Foot
Calcaneus fracture
Cuboid fracture
Cuneiform fractures
Dancer's fracture (5th MT spiral shaft)
Jones fracture (5th MT base - metadiaphyseal junction)
Lisfranc injury (tarsometatarsal dislocation)
March fracture (metatarsal stress fracture)
Metatarsal fractures (1st-5th)
Navicular fracture
Plantar fascia rupture
Talus fracture
Tibialis posterior tendon dysfunction
Toe dislocations
Cord syndromes
POCUS
Procedures
Medications
Calculators
Resuscitation
ECG Guide
Back
Clinical Assessment Checklist
Browse categories and answer follow-up questions to refine your symptom profile.
Approach to the Critical Patient
Initial stabilization
Incomplete spinal cord syndromes stabilization priorities
▶
Airway and ventilation
▶
High cervical injury concern
▶
Early airway control threshold lower with progressive respiratory weakness
Spine motion restriction
▶
Neutral alignment
▶
Avoid hypotension and hypoxia during transfers
Hemodynamic targets
▶
MAP augmentation strategy
▶
MAP 85 to 90 mmHg for 7 days post acute SCI recommendation :contentReference[oaicite:0]{index=0}
Time-critical consultation and transfer
▶
Neurosurgery or spine surgery early involvement
▶
Ongoing neurologic deficit or radiographic instability
Cord syndrome pattern recognition
Incomplete cord syndrome pattern flags
▶
Central cord syndrome pattern
▶
Disproportionate upper extremity weakness
▶
Lower extremity relative sparing common :contentReference[oaicite:1]{index=1}
Anterior cord syndrome pattern
▶
Motor weakness below lesion
▶
Pain and temperature loss with dorsal column sparing
Brown-Sequard syndrome pattern
▶
Ipsilateral weakness and proprioception loss
▶
Contralateral pain and temperature loss :contentReference[oaicite:2]{index=2}
Secondary injury prevention
Secondary injury prevention bundle
▶
Hypotension avoidance
▶
SBP and MAP support prioritized
▶
Neurogenic shock consideration
Hypoxia avoidance
▶
Continuous pulse oximetry
▶
Early ventilatory support if declining FVC or rising CO2
Temperature and glucose
▶
Normothermia
▶
Hyperglycemia avoidance
History
Mechanism and symptom timeline
ABCs, oxygenation, ventilation targets
▶
Need for airway protection or impending fatigue
Diaphragmatic weakness signs, NIF and VC when indicated
Spinal motion restriction when traumatic mechanism or unstable exam
▶
Cervical collar fit and neutral positioning
Log roll precautions and pressure injury prevention
Hypotension avoidance, shock evaluation, resuscitation targets
▶
Consider neurogenic shock if hypotension with bradycardia and warm extremities
Consider hemorrhagic shock with tachycardia, cool extremities, obvious trauma
Baseline neuro exam before sedation or paralytics
▶
Document motor, sensory, reflexes, perianal findings
Time stamp exam and repeat after interventions
Emergent decompression triggers
▶
Progressive motor deficit
Urinary retention or new incontinence
Saddle anesthesia
Rapidly evolving myelopathy
Imaging pathway
▶
MRI spine when compressive lesion, cauda equina, conus, infection, tumor suspected
CT spine when fracture or alignment concern, or MRI delay
High risk specific etiologies
▶
Epidural abscess
▶
Start antibiotics after blood cultures if unstable or high suspicion
Urgent spine consultation
Epidural hematoma
▶
Reverse anticoagulation per agent
Urgent spine consultation
Malignant compression
▶
Dexamethasone per local protocol
Urgent oncology and spine pathway
Physical Exam
Neurologic examination
General and vital signs
▶
Fever
Hypotension with bradycardia
Respiratory compromise indicators
Spine exam
▶
Midline tenderness
Step off or deformity
Range limitation and guarding
Motor exam
▶
Strength by myotomes
▶
Shoulder abduction C5
Elbow flexion C5 to C6
Wrist extension C6
Elbow extension C7
Finger flexion C8
Finger abduction T1
Hip flexion L2
Knee extension L3
Ankle dorsiflexion L4
Great toe extension L5
Ankle plantarflexion S1
Symmetry, proximal vs distal
Tone, spasticity vs flaccidity
Reflexes and UMN signs
▶
Hyperreflexia
Clonus
Babinski
Hoffmann
Sensory exam
▶
Light touch
Pinprick
Temperature
Vibration
Proprioception
Map sensory level and side to side differences
Perineal and sacral exam when indicated
▶
Perianal sensation
Anal wink
Voluntary anal contraction
Rectal tone
LMN pattern checks
▶
Areflexia
Fasciculations, atrophy when chronic
Dermatomal radicular sensory loss
Reassessment plan
▶
Repeat after analgesia, reduction, imaging transfer, immobilization changes
Syndrome-specific exam patterns
Cord syndrome exam patterns
▶
Central cord syndrome
▶
Upper extremity weakness greater than lower extremity
▶
Hand intrinsic weakness and dexterity impairment common :contentReference[oaicite:4]{index=4}
Anterior cord syndrome
▶
Motor loss below lesion
▶
Loss of pain and temperature below lesion
Brown-Sequard syndrome
▶
Ipsilateral motor weakness below lesion
▶
Contralateral pain and temperature loss below lesion :contentReference[oaicite:5]{index=5}
Differential Diagnosis
Differential Diagnosis
Compressive
▶
Fracture, dislocation
Disc herniation
Epidural hematoma
Epidural abscess
Tumor
Vascular
▶
Anterior spinal artery infarct
Spinal AVM
Inflammatory demyelinating
▶
Transverse myelitis
MS
NMOSD
MOGAD
Mimics
▶
Guillain-Barre
Brain stroke when no sensory level and cranial findings
Metabolic posterior column disease
▶
B12 deficiency
Copper deficiency
Laboratory Tests
Baseline and resuscitation labs
Laboratory evaluation considerations
▶
Trauma baseline
▶
CBC for hemorrhage concern
▶
Hemoglobin trend with ongoing instability
Electrolytes and renal function
▶
Creatinine for contrast planning
▶
Hyperkalemia concern with crush injury
Coagulation profile
▶
INR and aPTT with anticoagulant exposure
▶
Reversal planning linkage
Type and screen
▶
High-energy trauma
▶
Anticipated operative pathway
Targeted labs by presentation
Targeted labs for cord syndrome complications
▶
Venous blood gas
▶
Hypercapnia concern with hypoventilation
▶
Rising PCO2 threshold for ventilatory support
Lactate
▶
Shock physiology marker
▶
Persistent elevation triggers broader hemorrhage search
Diagnostic Tests
Scoring Systems
Neurologic and functional scoring
▶
ASIA Impairment Scale documentation
▶
Baseline grade A to E
▶
Serial reassessment after resuscitation and imaging
MAP augmentation candidacy framework
▶
Neurogenic shock suspicion
▶
Bradycardia with hypotension
Radiographs
Initial imaging radiographs
▶
Cervical spine radiographs when CT unavailable
▶
Cross-table lateral screening
▶
Limited sensitivity compared with CT in trauma
Chest radiograph
▶
Associated trauma screening
▶
Aspiration or pulmonary contusion context
MRI
MRI spine indications
▶
Neurologic deficit with negative CT
▶
Ligamentous injury evaluation
▶
Central cord syndrome cord edema and hemorrhage characterization :contentReference[oaicite:9]{index=9}
Suspected compressive lesion
▶
Epidural hematoma
▶
Surgical decompression planning
Prognostication markers
▶
Cord hemorrhage vs edema
▶
Worse prognosis with hemorrhage in central cord syndrome :contentReference[oaicite:10]{index=10}
CT
CT spine diagnostic role
▶
First-line imaging for blunt cervical trauma with neurologic deficit
▶
Fracture and alignment assessment
▶
Facet fracture or dislocation detection
CT angiography when vascular injury concern
▶
Cervical fracture patterns with vertebral artery injury risk
▶
Focal posterior circulation symptoms
Disposition
Admission and transfer criteria
Disposition pathway for cord syndromes
▶
ICU admission indications
▶
MAP augmentation need
▶
Vasopressor infusion requirement
Step-down admission indications
▶
Stable hemodynamics with persistent deficit
▶
Ongoing neuro checks
Transfer indications
▶
No spine surgery capability
▶
Need for urgent decompression or stabilization
Follow-up and rehabilitation planning
Copy
Post-acute disposition planning
▶
Inpatient rehabilitation early involvement
▶
PT and OT consultation
▶
Hand function focus for central cord syndrome
Bladder management planning
▶
Intermittent catheterization program
▶
Urology involvement as needed
Treatment
Immediate life-saving interventions
Life-saving priorities for suspected acute SCI
▶
Oxygenation and ventilation support
▶
Assisted ventilation threshold if declining respiratory mechanics
▶
ICU airway planning
Hemodynamic support
▶
Neurogenic shock pathway
▶
Vasopressor infusion for MAP target
▶
Norepinephrine infusion
▶
Initiate 0.05 mcg/kg/min
Titrate every 2 to 5 minutes to MAP target 85 to 90 mmHg :contentReference[oaicite:11]{index=11}
Typical range 0.05 to 0.5 mcg/kg/min
Phenylephrine infusion
▶
Initiate 0.5 mcg/kg/min
Titrate every 2 to 5 minutes to MAP target
Typical range 0.5 to 5 mcg/kg/min
Vasopressin adjunct
▶
Fixed dose 0.03 units/min
Catecholamine sparing option
Analgesia compatible with neuro reassessment
▶
Acetaminophen PO or IV
▶
Max 4 g per day
Opioid titration if severe pain
▶
Fentanyl IV 25 to 50 mcg
▶
Repeat every 5 to 10 minutes as needed with monitoring
Steroid therapy decision support
▶
MPSS 24-hour infusion option within 8 hours adult acute SCI
▶
Moderate evidence and weak recommendation in guideline :contentReference[oaicite:12]{index=12}
Not recommended after 8 hours :contentReference[oaicite:13]{index=13}
CAEP position statement
▶
MPSS as optional therapy with weak evidence level II to III :contentReference[oaicite:14]{index=14}
Immobilization and Splinting
Spine immobilization strategy
▶
Cervical collar
▶
Proper sizing and neutral alignment
▶
Skin pressure injury monitoring
Log-roll precautions
▶
Team-based turns
▶
Maintain alignment during transfers
Remove collar only with spine specialist clearance
▶
MRI based clearance in obtunded patient context
▶
Institutional protocol alignment
Reduction
Spinal reduction concepts when fracture-dislocation present
▶
Urgent reduction when progressive neurologic deficit
▶
Neurosurgery led plan
▶
Traction protocol per specialist
Avoid forceful repeated attempts
▶
Worsening neurologic status trigger stop
▶
Immediate specialist escalation
Post-reduction imaging
▶
CT alignment confirmation
▶
MRI for cord compression reassessment
Open fracture medications and timing
Penetrating spine injury considerations
▶
Open wound contamination pathway
▶
Broad-spectrum antibiotics per penetrating trauma protocol
▶
Tetanus prophylaxis logic per immunization status
CSF leak suspicion
▶
Neurosurgery involvement
▶
Dural repair planning
DVT prophylaxis when relevant
VTE prophylaxis planning in acute SCI
▶
Mechanical prophylaxis
▶
Intermittent pneumatic compression
▶
Early initiation if no contraindication
Pharmacologic prophylaxis
▶
LMWH per local protocol after bleeding risk assessment
▶
Timing coordinated with neurosurgery and imaging
Special Populations
Pregnancy
Pregnancy considerations in acute SCI
▶
Maternal resuscitation prioritized
▶
Left uterine displacement after mid-pregnancy
▶
Aortocaval compression mitigation
Imaging considerations
▶
MRI preferred when feasible
▶
CT when clinically necessary
Medication safety
▶
Avoid teratogenic agents
▶
Obstetric consultation early
Geriatric
Geriatric considerations
▶
Central cord syndrome risk with cervical spondylosis
▶
Hyperextension ground-level fall association :contentReference[oaicite:15]{index=15}
Delirium risk
▶
Minimize sedatives
▶
Frequent reorientation and pain control balance
Higher complication risk
▶
Pressure injury prevention
▶
Early mobilization planning with rehab
Pediatrics
Pediatric considerations
▶
SCIWORA consideration
▶
MRI despite normal CT in neurologic deficit
▶
Ligamentous injury and cord edema detection
Weight-based dosing
▶
Vasopressor and analgesic dosing by kg
▶
Pediatric critical care involvement
Nonaccidental trauma screening
▶
Inconsistent mechanism history
▶
Safeguarding protocol
Background
Epidemiology
Epidemiology overview for incomplete SCI syndromes
▶
Central cord syndrome common incomplete SCI subtype
▶
Older adults with degenerative stenosis overrepresented :contentReference[oaicite:16]{index=16}
Brown-Sequard syndrome uncommon
▶
Often penetrating or lateralized injury mechanisms :contentReference[oaicite:17]{index=17}
Anterior cord syndrome uncommon
▶
Vascular compromise mechanism consideration
Pathophysiology
Pathophysiology by syndrome
▶
Central cord syndrome mechanism
▶
Central cord gray matter and corticospinal tract involvement
▶
Upper limb motor fibers more medial vulnerability concept
Anterior cord syndrome mechanism
▶
Anterior spinal artery territory injury
▶
Corticospinal and spinothalamic tract involvement with dorsal column sparing
Brown-Sequard syndrome mechanism
▶
Hemisection pattern
▶
Ipsilateral corticospinal and dorsal column disruption with contralateral spinothalamic loss :contentReference[oaicite:18]{index=18}
Therapeutic Considerations
Therapeutic rationale
▶
MAP augmentation rationale
▶
Spinal cord perfusion support and secondary injury mitigation
▶
Guideline recommendation MAP 85 to 90 mmHg for 7 days :contentReference[oaicite:19]{index=19}
Steroid therapy controversy
▶
MPSS within 8 hours as optional therapy with weak recommendation :contentReference[oaicite:20]{index=20}
▶
Complication risk consideration
Surgical decompression and stabilization
▶
Ongoing compression or instability scenarios
▶
Early specialist decision-making
Patient Discharge Instructions
Copy discharge instructions
Copy
Discharge instructions for incomplete cord syndromes after inpatient evaluation
▶
Return immediately
▶
New weakness
New numbness
New bowel or bladder dysfunction
New saddle anesthesia
Worsening neck or back pain
Fever with spinal pain
Activity restrictions
▶
Cervical collar adherence if prescribed
▶
No driving with collar unless cleared
Skin care
▶
Collar skin checks twice daily
▶
Pressure sore warning signs
Rehab plan adherence
▶
PT and OT appointments
▶
Hand therapy focus when indicated
Medications
▶
Avoid sedating meds unless prescribed
▶
Opioid safety and constipation prevention
References
Clinical practice guidelines and reviews
Guideline and evidence sources
▶
MAP management guideline recommendation
▶
AOSpine clinical practice guideline summary of MAP 85 to 90 mmHg for 7 days :contentReference[oaicite:21]{index=21}
Steroid guideline
▶
AOSpine guideline on MPSS within 8 hours as optional weak recommendation :contentReference[oaicite:22]{index=22}
CAEP position statement on steroids in acute SCI
▶
MPSS protocol as optional therapy with weak evidence :contentReference[oaicite:23]{index=23}
Central cord syndrome reference
▶
NCBI Bookshelf StatPearls central cord syndrome overview :contentReference[oaicite:24]{index=24}
Brown-Sequard syndrome reference
▶
NCBI Bookshelf StatPearls Brown-Sequard syndrome overview :contentReference[oaicite:25]{index=25}
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.
← Orthopedic Injuries
Home
Orthopedic Injuries
Cord syndromes