Neurology

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

1. sensory loss
2. motor loss
3. 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