FF - Dermatomes, Myotomes, Reflexes, ULTT, SLR, Slump tests

Dermatomes

C1

Vertex of skull

C2

Temple, forehead, occiput

C3

Entire neck, posterior cheek, temporal area, prolongation forward under mandible

C4

Shoulder area, clavicular area, upper scapular area

C5

Deltoid area, anterior aspect of entire arm to base of thumb

C6

Anterior arm, radial side of hand to thumb and index finger

C7

Lateral arm and forearm to index, long, and ring fingers

C8

Medial arm and forearm to long, ring, and little fingers

T1

Medial side of forearm to base of little finger

T2

Medial side of upper arm to medial elbow, pectoral and midscapular areas

T3-T6

Upper thorax

T5-T7

Costal margin

T8-T12

Abdomen and lumbar region

L1

Back, over trochanter and groin

L2

Back, front of thigh to knee

L3

Back, upper buttock, anterior thigh and knee, medial lower leg

L4

Medial buttock, lateral thigh, medial leg, dorsum of foot, big toe

L5

Buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first, second, and third toes

S1

Buttock, thigh, and leg posterior

S2

Same as S1 (Buttock, thigh, and leg posterior)

S3

Groin, medial thigh to knee

S4

Perineum, genitals, lower sacrum

Myotomes

C1-C2

Cervical flexion

C3

Cervical side flexion

C4

Scapular elevation

C5

Shoulder abduction

C6

Elbow flexion and wrist extension

C7

Elbow extension and wrist flexion

C8

Thumb extension

T1

Finger abduction

L1-L2

Hip flexion

L3

Knee extension

L4

Ankle dorsiflexion

L5

Big toe extension

S1

Ankle eversion and plantarflexion, hip extension

S2

Knee flexion

S3

No specific test action; intrinsic foot muscles (except abductor hallucis)

What is the afferent pathway of the corneal reflex?

Ophthalmic branch (V1) of the trigeminal nerve (CN V)

What is the efferent pathway of the corneal reflex?

Facial nerve (CN VII)

What response is expected with a normal corneal reflex?

Blinking of both eyes

What spinal cord levels are tested with the abdominal reflex?

T7-T12

How is the abdominal reflex performed?

Lightly stroke the abdomen from lateral to medial

What is the normal response to the abdominal reflex?

Contraction of the superficial abdominal muscles

What does an asymmetric or absent abdominal reflex suggest?

An upper motor neuron (UMN) lesion on the absent side

What spinal cord levels are tested with the cremasteric reflex?

L1-L2

How is the cremasteric reflex elicited?

Stroke the superior/inner thigh on one side

What is the normal response to the cremasteric reflex?

Contraction of the cremaster muscle, pulling the testis/scrotum upward

When is the cremasteric reflex absent?

Spinal cord injury (SCI) and corticospinal tract lesions

What spinal cord levels and nerve are involved in the plantar reflex?

S1-S2 via the tibial nerve

How is the plantar reflex performed?

Stroke the lateral sole of the foot from the calcaneus to the base of the 5th metatarsal

What is the normal response to the plantar reflex?

Plantarflexion (curling) of the toes

What is a positive Babinski sign?

Dorsiflexion of the great toe with fanning of the other four toes

What does a positive Babinski sign indicate?

Corticospinal tract damage or an upper motor neuron (UMN) lesion

What is the anal reflex?

Reflexive contraction of the external anal sphincter when the skin around the anus is stroked

What is the afferent nerve of the anal reflex?

Pudendal nerve

What spinal cord levels mediate the anal reflex?

S2-S4

What is the bulbocavernosus reflex?

Contraction of the anal sphincter when the glans penis is squeezed or an indwelling Foley catheter is tugged

What spinal cord levels mediate the bulbocavernosus reflex?

S2-S4

Why is the bulbocavernosus reflex clinically important after a spinal cord injury?

It is the first reflex to return after SCI and indicates the patient is out of spinal shock

Grading of DTR

0 = No Response, always abnormal

1+ = Slight reflex, present but depressed, low normal

2+ = Normal, typical reflex

3+ = Brisk reflex, possibly but not necessarily abnormal

4+ = Very brisk reflex, abnormal, clonus

C5-C6

Biceps reflex

C5-C6

Brachioradialis

C7-C8

Triceps

L2-L4

Patellar

Achilles Tendon

S1-S2

Hamstrings

L5-S2

ULTT 1

Nerve bias for ULTT 1

Median nerve, anterior interosseous nerve, C5, C6, C7

Think MAIN

ULTT 2

Nerve bias for ULTT 2

Median nerve

Axillary

Musculocutaneous

(MAM)

ULTT 3

Nerve bias for ULTT 3

Radial nerve

ULTT 4

Nerve bias for ULTT 4

Ulnar nerve, C8 and T1 nerve roots

SLR 1

Hip flexion and ADD

Knee ext

Ankle DF

Nerve bias SLR 1

Sciatic and tibial

SLR 2

Hip flexion

Knee ext

Ankle DF

Foot EVER

Toes ext

Nerve bias for SLR 2

Tibial

SLR 3

Hip flexion

Knee ext

Ankle DF

Foot INV

Nerve bias for SLR 3

Sural

SLR 4

Hip flexion and MED ROT

Knee ext

Ankle PF

Foot INV

Nerve bias for SLR 4

Common peroneal

SLR 5 Cross

Hip flexion

Knee ext

Ankle DF

Nerve bias for SLR 5

Nerve root (disc prolapse)

Slump test 1

Cervical flexion

Thoracic and lumbar spine flexion

Hip flexion (90)

Knee extension

Ankle DF

Nerve bias for ST1

Spinal cord, cervical and lumbar nerve roots, sciatic nerve

Slump test 2

Cervical flexion

Thoracic and lumbar spine flexion

Hip flexion (90) and ABDUCTION

Knee extension

Ankle DF

Nerve bias for ST2

Obturator nerve

Slump test 3 side lying

Cervical flexion

Thoracic and lumbar spine flexion

Hip flexion (20)

Knee flexion

PF

Nerve bias for ST3

Femoral nerve

Slump test 4 long sitting

Cervical flexion and rotation

Thoracic and lumbar spine flexion

Hip flexion (90)

Knee extension

DF

Nerve bias for ST4

Spinal cord, cervical and lumbar nerve roots, sciatic nerve