Palpation of Helen revealed tissue texture changes bilaterally at T2-T5 that were cold, dry, and ropy. The red reflex test demonstrated rapid left-sided blanching of T3-T5 and right sided rapid flare followed by pronounced blanching at T4-5. Further palpation revealed dry and cool skin texture at T2-T5. Motion testing revealed resistance to right rotation T1-T5 as well.