Dermatomes, Reflexes, and Testing

Question 1

Testing L2-L4

Answer 1

Difficulty with squatting to standing

Question 2

Test L3

Answer 2

Pinprick test of the knee (decreased or absent sensation suggests pathology)

Question 3

Test L4

Answer 3

Dorsiflexion

Heel walking

Question 4

Testing L5-S1

Answer 4

Straight leg raise (sciatic pain = abnormal —> pathology of L5 or S1)

Question 5

C3

Answer 5

Back of neck

Question 6

C6

Answer 6

Radial side of forearm
Thumb
Radial side of pointer finger

Question 7

C8

Answer 7

Ulnar side of forearm
Pinky
Ulnar side of ring finger

Question 8

T4

Answer 8

Nipples

Question 9

T10

Answer 9

Umbilicus

Question 10

L1

Answer 10

Inguinal region

Question 11

L4

Answer 11

Knee

Question 12

S5

Answer 12

Perianal

Question 13

L5

Answer 13

Anterior ankle and foot

Question 14

Biceps reflex

Answer 14

C5, C6

Question 15

Triceps Reflex

Answer 15

C6, C7

Question 16

Brachioradialis Reflex

Answer 16

C5, C6

Question 17

Quadriceps (Patellar) Reflex

Answer 17

L2, L3, L4

Question 18

Achilles (Ankle) Reflex

Answer 18

L5, S1

Question 19

Plantar Response

Answer 19

L5, S1

Question 20

Brudzinski Sign

Answer 20

Supine patient
Flex the neck forward until the chin touches the chest

POSITIVE: flexion of hips and knees

Question 21

Kernig Sign

Answer 21

Supine patient
Flex patient’s leg at hip and knee
Slowly extend leg & straighten knee

NORMAL: discomfort behind knee during full extension
POSITIVE: pain and increased resistance to leg extension

Question 22

Straight Leg Raise (purpose, how to test, positive)

Answer 22

PURPOSE: testing for lumbosacral radiculopathy

Patient supine
Raise patient’s relaxed and straightened leg, flexing at hip
OR flex the knee, raise the patient’s leg, then extend the leg

POSITIVE: pain radiating into leg when sciatic nerve is stretched by extending the leg (pathology at L5 or S1)
NORMAL: tightness or discomfort in buttocks or hamstrings (do not confuse this for radiating pain)

Question 23

Apley Grind Test (purpose, how to test, positive test)

Answer 23

PURPOSE: evaluate knee symptoms with suspected meniscus injury

TESTING:
patient prone
bend knee to 90 degrees
compress sole of foot and apply internal and external rotation to the foot/lower leg; use the other hand to stabilize the posterior thigh

POSITIVE: pain or restriction when sole of foot compressed and internal and external rotation applied

Question 24

Lachman Test

Answer 24

PURPOSE: to diagnose an ACL injury

HOW TO TEST:
patient supine with knee in 15 degrees of flexion
stabilize femur on lateral side with one hand and proximal tibia on medial side with the other
thumb of tibial hand on joint line
simultaneously pull tibia forward and femur back

POSITIVE: significant forward excursion = positive for ACL tear

Question 25

McMurray Test (purpose, how to test, positive)

Answer 25

PURPOSE: to evaluate suspected meniscus injury HOW TO TEST: supine patient grasp heel and flex knee cup hand over knee going with fingers and thumb along medial joint line externally rotate lower leg from heel then push on lateral side to apply VALGUS stress on medial side of joint simultaneously slow extend lower leg in external rotation REPEAT same maneuver with internal rotation of foot FURTHER ASSESS if a click is felt or heard during flexion or extension of the knee OR if tenderness noted along joint line POSITIVE: pain, snapping, audible clicking, locking

Question 26

define: VALGUS

Answer 26

knock-kneed | knees are medially displaced

Question 27

define: VARUS

Answer 27

knees are laterally displaced | bow-legged

Question 28

Phalen Test

Answer 28

PURPOSE: to diagnose carpal tunnel syndrome TO TEST: patient's wrist in complete unforced flexion for 30 seconds to attempt to elicit nerve entrapment sx, e.g. tingling hold the dorsal side of the hands together POSITIVE: tingling in thumb, index finger, middle finger, and lateral half of ring finger indicates carpal tunnel syndrome via pressure on median nerve

Question 29

Squat and Stand

Answer 29

L2-L4 innervates hip flexors and knee extensors POSITIVE: difficulty or inability to squat (pathology with L2-L4 nerve roots)

Question 30

Heel Walking

Answer 30

PURPOSE: evaluate L4-L5 POSITIVE: difficulty or inability to stand or walk on heels

Question 31

Toe Walking

Answer 31

PURPOSE: test S1 nerve roots POSITIVE: difficulty or inability to walk on toes (pathology of S1 nerve roots)

Question 32

Hawkins-Kennedy Test (purpose, how to test, positive test)

Answer 32

PURPOSE: to test for subacromial impingement syndrome WEAK TEST: sensitivity 58-80%; specificity 56-70%; inter-rater reliability of 0.38 TESTING: patient seated affected arm in 90 degrees of shoulder flexion elbow flexed to 90 degrees examiner fixates scapula with one hand and holds patient's elbow with other hand add passive internal rotation of glenohumeral joint POSITIVE: reproduction of shoulder pain

Question 33

NAME OF TEST (purpose, how to test, positive test)

Answer 33

PURPOSE: TESTING: POSITIVE: