1. Orthopaedic Neurology
Diagnostic Guide to Neurological Levels

2. Motor Power
Interruption of the nerve root causes denervation and paralysis of its myotome.
Pressure on a nerve root can cause a decrease in muscle strength.
Muscle testing is utilized to evaluate whether or not a lesion is present and to what degree it is effecting the muscle strength.

3. Muscle Grading Chart Muscle gradations Description.
5 – normal
4 – good
3 – fair
2 – poor
1 – trace
0 - zero
Description.
Complete range of motion against gravity with full resistance.
Complete range of motion against gravity with some resistance.
Complete range of motion against gravity.
Complete range of motion with gravity eliminated.
Evidence of slight contractility. No joint motion.
No evidence of contractility.

4. Sensation
Pathology to the cord or nerve root results in loss of light touch, followed by loss of sensation of pain.
During recovery from nerve root injury, sensation of pain returns before light touch.

5. Sensation
The 2 sensations are tested separately, light touch with a cotton swab, pain with pinpricks.
Pinwheels can be utilized to evaluate sensation.
Results can be recorded on a dermatome chart as normal, hyperesthetic (increased), hyposthetic (decreased), dyesthetic (altered), or anesthetic (absent).

6. Reflex
Interruption in the basic reflex arc results in the loss of reflex, while pressures on the nerve root itself may decrease its intensity (hyporeflexia).
Interruption of the upper motor neuron’s regulatory control results in a hyperactive nerve (hyperreflexia).
Reflexes should be reported as normal, increased, or decreased utilizing bilateral comparison.

7. Stretch Reflex Arc

8. Nerve Root Lesions by Neurologic Level

9. Evaluation of Nerve Root Lesions
Upper Extremity

10. Cervical Spine
C5 is the 1st significant contribution to the brachial plexus.
C1-4 are difficult to test; However, C4 is the major innervation to the diaphragm (via the phrenic nerve).

11. The Cervical Spine

14. Deltoid & Supraspinatous

15. Elbow Flexion and Extension

16. Biceps Brachii & Brachialis

17. Functions of the Biceps

18. Muscle Test for the Biceps

19. Biceps Reflex Test

20. Memory Trick

21. Muscle Test Shoulder Abduction

22. Sensory Distribution C5

24. Wrist Extension and Flexion

25. Extensor Carpi Ulnaris (Left), Extensor Carpi Radialis (Right)

26. Muscle Test Wrist Extension

27. Brachioradialis Reflex Test

28. Memory Trick

30. Triceps Brachii

31. Walking With a Crutch Utilizes the Triceps Muscle

32. Muscle Test Wrist Flexors

33. Flexor Carpi Radialis (Left), Flexor Carpi Ulnaris (Right)

34. Finger Extension and Flexion

35. Extensor Digitorum

36. Muscle Test Finger Extension

37. Triceps Reflex Test

39. Flexor Digitorum Superficialis (Left), and Profundus (Right)

40. Lumbricales

41. Muscle Test Finger Flexors

42. Memory Trick

44. Finger Abduction and Adduction

45. Muscle Test Finger Abduction

46. Muscle Test Finger Adduction

47. Summary of Muscle Testing for the Upper Extremity

48. Summary of Reflex Testing for the Upper Extremity

49. Summary of Sensation for the Upper Extremity

50. Cervical Vertebrae and Nerve Roots

51. Herniated Cervical Disc

52. Occiput & C1 Articulation

53. C1 and C2 Articulation

54. Anatomic Basis for Posterior Cervical Disc Herniation

60. Neurologic Levels in Upper Extremity
Motor
C5 – shoulder abduction
C6 – wrist extension
C7 – wrist flexion and finger extension
C8 – finger flexion
T1 – finger abduction, adduction

61. Neurologic Levels in Upper Extremity
Sensation
C5 – lateral arm
C6 – lateral forearm, thumb, and index finger
C7 – middle finger (variable)
C8 – medial forearm, ring, and small finger
T1 – medial arm
T2 - Axilla

62. Neurologic Levels in Upper Extremity
Reflex
C5 – biceps
C6 – Brachioradialis
C7 - triceps

64. Whiplash Injury to the Cervical Spine

65. Anatomy of a Cervical Vertebrae

66. Orthopedic Tests Cervical Spine
Valsalva test
Distraction test
Compression test

67. Valsalva Test

68. Distraction Test

69. Compression Test

70. Thoracic Spine

71. Beevor’s Spine

72. Hip Flexion

73. Iliopsoas

74. Muscle Test Iliopsoas

75. Knee Extension

76. Rectus Femoris (Left), Vastus Intermedius and Lateralis (Right)

77. Extension Lag

78. Muscle Test Quadriceps

79. Hip Adduction

80. Adductors

81. Muscle Test Hip Adductors

82. Dermatomes of the Lower Extremity

84. Foot Inversion

85. Muscle Test Tibialis Anterior

86. Patellar Tendon Reflex

87. Memory Trick

89. Foot Dorsiflexion (Ankle Extension)

90. Extensor Hallucis Longus

91. Muscle Test Extensor Hallucis Longus

92. Muscle Test Toe Extensors

93. Memory Trick

94. Hip Abduction

95. Gluteus Medius

96. Muscle Test Gluteus Medius

97. L5 Sensory Dermatome

99. Foot Eversion

100. Peroneus Longus & Brevis

101. Muscle Test Peronei Muscles

102. Foot Plantarflexion

103. Gastrocnemius & Soleus

104. Muscle Test Gastrocnemius

105. Hip Extension

106. Gluteus Maximus

107. Muscle Test Gluteus Maximus

108. Achilles Reflex Test

109. Memory Trick

110. Sensory Dermatomes S2, S3, S4, S5

111. Sensory Dermatomes L4-S1

112. Testing Sensation

113. Anatomic Basis for Posterior Lumbar Disc Herniation

117. Neurologic Levels in Lower Extremity
Motor
L3 – quadriceps (L2, L3, L4)
L4 – Tibialis anterior
L5 – toe extensors
S1 - Peronei

118. Neurologic Levels in Lower Extremity
Sensation
T12 – lower abdomen just proximal to inguinal ligament
L1 – upper thigh just distal to inguinal ligament
L2 – mid thigh
L3 – lower thigh
L4 – medial leg – medial side of foot
L5 – lateral leg – dorsum of foot
S1 – lateral side of foot
S2 – longitudinal strip, posterior thigh

120. Neurologic Levels in Lower Extremity
Reflex
L4 – patellar
L5 – Tibialis posterior (difficult to obtain)
S1 – Achilles tendon