Cauda equina syndrome

Physical Examination

• Inspection: muscle atrophy (esp. quads and calves), fasciculations
• Palpation
  • Spinous processes, ligaments, and disc spaces
  • Muscle bulk/atrophy, fasciculations
• Tone: may be decreased, including anal tone
• Motor: all lower extremity movements
• Reflexes:
  • Decreased or absent DTRs in LE
  • Downgoing plantar reflexes
• Sensory
  • Decreased in L1-S1
  • Perineal anesthesia (also check anal tone)
• Gait