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afferent
sensory information sent to posterior/dorsal roots
efferent
motor information sent from the anterior root
reflex arc
one way street within the spinal cord. not sent to the brain
nerve injuries
compression or tension
types of nerve trauma
invasive (laceration/puncture) noninvasive (repetitive motion) impingement
order of symptoms in nerve root injury
sensory loss
motor loss
reflex loss
in case of nerve root injury
SPINE BOARD ASAP
myotome
motor- muscle or group of muscles supplied by a specific spinal nerve
dermatome
sensory - Area of skin supplied by a single spinal nerve
grading of dermatome test
hypoesthesia: diminished sensation hyperesthesia: increased sensation anesthesia: total loss paraesthesia: abnormal (tingling/numbness)
how dermatomes are tested
sharp/dull discrimination 2-point discrimination light touch
*5 stimuli in 3 different regions of dermatome
myotome grading
positive (not firing) negative (firing)
*nerve sends a signal or it doesn't
types of myotome testing
Break testing (put patient in position and try to break them out of it (resistance)) manual resistance exercises
C1
dermatome: no cutaneous myotome: neck flexion
C2
dermatome: temple, forehead, occiput, FACE myotome: neck rotation
C3
dermatome: back of neck and scalp myotome: lateral neck flexion (look to side)
C4
dermatome: back/side of neck, clavicle and acromion myotome: shoulder elevation
C5
dermatome: lower shoulder, radial arm myotome: shoulder abduction
axillary nerve
C6
dermatome: radial forearm, scaphoid/thumb myotome: elbow flexion and wrist extension
Radial nerve
C7
dermatome: central palm/dorsal - middle 3 fingers myotome: elbow extension or wrist flexion
median nerve
C8
dermatome: ulnar side of hand and wrist myotome: finger flexion, ulnar deviation
ulnar nerve
T1
dermatome: ulnar forearm and upper arm (elbow) myotome: finger abduction
T2
dermatome: armpit, pectoral, and mid scap
L1
dermatome: low abs, groin and buttock *DO NOT TEST
L2
dermatome: low back and anterior thigh myotome: hip flexion
L3
dermatome: medial thigh to knee myotome: knee extension
L4
dermatome: medial lower leg to big toe myotome: dorsiflexion and inversion
L5
dermatome: lateral leg, toes and sole of foot myotome: great toe extension
L5/S1 myotome
planar flexion
S1/S2 myotome
plantar flexion and eversion
S1
dermatome: posterior low leg, heel, and pinky toe myotome: plantar flexion
S2
dermatome: posterior leg to gluteal fold myotome: knee flexion
S3
dermatome: central glute area *DO NOT TEST
S4
dermatome: saddle area myotome: genitals/bladder *DO NOT TEST
L2, L3, L4 Reflex
Patellar Tendon
S1 and S2 Reflex
Achilles Tendon
C5 Reflex
Biceps Tendon
C6 Reflex
brachioradialis
C7 Reflex
triceps tendon
Reflex Grading
0 = none 1+ = hyporeflexia 2+ = normal 3+ = hyperreflexia 4+ = hyperreflexia w/ clonus
Jendrassik maneuver
technique to distract patient to better relax LE reflex = hook fingers and pull apart UE reflex = cross ankle and pull apart
Break Testing Grading
Positive = muscle didn't fire Negative = muscle fired
Pathological Reflex
sign of stroke or heart attack
Babinski's Oppenheim's Hoffman's