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Thread: Injury Level Question for SCI-Nurse

  1. #1
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    Injury Level Question for SCI-Nurse

    This is a question for experts on SCI diagnosis.
    I've never had a real ASIA work-up. My original doc called me a T3-T7 ASIA A, but ASIA can only have one level, not a range.
    As I understand it the level is the first dermatome level where touch tests are different from normal.

    So in my case the question is this:
    If I have odd sensations in my left arm and left scapula area does this reflect my true ASIA score?
    Basically if I brush something along my left arm, I can "feel" a phantom of the same motion on my leg.
    Likewise if I scratch or rub something over my left scapula, I feel a similar sensation in my left foot.

    So what does that mean?
    T3 complete since Sept 2015.

  2. #2
    Technically your ISNCSCI (no longer called the ASIA) level of injury is based on the lowest level which has a 3 or better motor score and a normal sensory score (which includes both light touch and pin prick). You can have a different score for right vs. left, which is how some people end up with a C5/C6 injury, for example, but you are correct, you usually are not going to be properly rated as T7-T10.

    There are no motor scores done for the thoracic levels of injury, so the sensory exam alone is used to give the level of injury in those areas.

    ISNCSCI stands for International Standards for the Neurological Classification of Spinal Cord Injury, while ASIA stands for the American Spinal Injury Association. ASIA joined together with ISCoS (the International Spinal Cord Society) to agree on this revised ASIA scale a number of years ago.

    The AIS (A, B, C, D, or E) part of your ISNCSCI exam stands for ASIA Impairment Scale, and indicates the completeness of your injury.

    It is impossible to tell what causes your arm sensory problems at this time. Have you always had these, or is this recent? These would not be due to a thoracic level injury. Have you been evaluated for a possible ascending syrinx? Is it possible you also had a peripheral nerve injury (such as a brachial plexus injury) during your original accident? This are very common in motorcycle or bike accidents, for example.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  3. #3
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    I was riding a bicycle at 25 mph when a driver made an un-signaled left turn.
    Fractured C3, C4, T6 & T8; T7 was mostly obliterated.

    The arm and scapula sensations have been there from the start. I did have a substantial injury (laceration) to that arm, but no injury to the scapula.
    T3 complete since Sept 2015.

  4. #4
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    The car did hit me from the left of course so that side took a beating. Interestingly that side is less responsive to FES (need 10-20% more voltage for the same muscle contraction)
    T3 complete since Sept 2015.

  5. #5
    You don't need to have an injury to your scapula or other shoulder structures to have some brachial plexus injury. These injuries often occur in shoulder dislocations or over stretching of the shoulder in such accidents, usually were the victim is thrown some distance off their bike or motorcycle and their arm is seriously wrenched by the handlebars in the process.

    Many brachial plexus injuries heal over time because they are peripheral nerve injuries, but sometimes there is residual damage that does not heal. Now days such injuries would be considered for nerve grafting if they don't improve in 12 months post injury.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  6. #6
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    I have a T6 SCI, ASIA A, had a brachial plexus injury on my left arm due to it being a motorcycle accident but I have the same sensation Mize described where if I brush my arm I can feel it in my leg but for me it is my right side (opposite of the brachial plexes injury). Not sure if that is helpful or more confusing but it's nice to know I'm not the only one with a weird phantom sensation like that. Don't think I've heard anyone else mention that before.

  7. #7
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    I also have pretty severe dysesthesia over the 1-3" band of skin between my no-sensation body and my upper body where sensation is normal. In response to stimulus like fabric movement, this area can scream pain, itching, heat and cold simultaneously. Compounded ketamine/lidocaine/baclofen can knock it back temporarily, but then it returns even worse. Got some CBD/THC salve in CA that helped more, but that's gone. Any other ideas?
    T3 complete since Sept 2015.

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    Some people find athletic compression clothing helps reduce pain from movement of outer fabrics.

  9. #9
    Quote Originally Posted by Mize View Post
    I also have pretty severe dysesthesia over the 1-3" band of skin between my no-sensation body and my upper body where sensation is normal. In response to stimulus like fabric movement, this area can scream pain, itching, heat and cold simultaneously. Compounded ketamine/lidocaine/baclofen can knock it back temporarily, but then it returns even worse. Got some CBD/THC salve in CA that helped more, but that's gone. Any other ideas?
    Have you tried TENS? It can be helpful for radicular pain like this.

    Have you tried CBD oil without THC? This is available even in non-medical MJ states.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  10. #10
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    Compression helps for sure, but the worst area is the groove between my pecs and my parabelly where compression clothing cannot compress. I need to find some CBD salve. Interestingly, Ohio's MMJ law made all CBD illegal without a MMJ card though retailers are still selling it.
    T3 complete since Sept 2015.

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