LE MRS Flashcards
What nerve root is compressed by the L4/L5 disc?
L4
What nerve root is compressed by the L5/S1 disc?
L5
What ligaments in the lumbar spine often result in nerve root adhesions?
Transforaminal ligmaments
What muscle is tested for an L1 MRS?
Iliopsoas
What muscle is tested for an L2 MRS?
Iliopsoas
What muscle is tested for an L1 or L2 MRS?
Iliopsoas
What muscle group is tested for an L3 MRS?
Adductors
What muscle is tested for an L4 MRS primarily?
Tibialis anterior
What muscle is tested for an L4 MRS secondarily?
Quadriceps
What muscle is tested for an L5 MRS primarily?
Extensor hallicus longus and brevis
What muscle(s) is(are) tested for an L5 MRS secondarily?
Extensor digitorum longus and brevis and abductors
What muscle is tested for an S1 MRS primarily?
Fibularis longus and brevis
What muscle(s) is(are) tested for an S1 MRS secondarily?
Gastrocnemius, soleus, and gluteus maximus
Your patient has lateral elbow pain. What exam procedures are best to assess the soft tissue structures associated with plausible causes?
A. Varus Test
B. Valgus Test
C. Golfer’s Test
D. Cozen’s Test
E. Mill’s Test
ADE
A 30 year old woman complains of tingling and numbness in the medial portion of her hand extending into her little finger. Select all plausible differential diagnosis for this patient?
A C6 root.
B. C8 root
C. Nerve root entrapment in the cubital tunnel
D. Nerve entrapment in the cubital fossa
E. Carpal tunnel syndrome
BC
What nerve runs in the cubital fossa?
Median
What nerve runs in the cubital tunnel?
Ulnar
What history questions can be asked for a lower extremity motor evaluation?
Troubles with gait/difficulty walking
What are the actions of iliopsoas?
Hip flexion
Flexes the spine when seated
Where is the L1 dermatome?
Top of the thigh just distal to the inguinal ligament
How is an iliopsoas test formed for an L1-L2 nerve root MRS?
Patient supine, doctor flexes, abducts, and externally rotates the hip. Doctor presses leg into abduction and extension and stabilizes the opposite thigh
What is the open packed position for the hip?
30 degrees of flexion and abduction/external rotation
What is the L2 dermatome?
Middle of the thigh
If a patient is leaning to the left side and has pain on their right. Where is the disc lesion?
Lateral to the nerve root
If a patient is leaning to the right and has pain on their right. Where is the disc lesion?
Medial to the nerve root
What is the L1 MRS reflex?
NONE
What is the L2 MRS primary reflex?
NONE
What is the L2 MRS secondary reflex?
Patellar tendon
What is the L3 MRS primary reflex?
NONE
What is the L3 MRS secondary reflex?
Patellar tendon
Where is the L3 dermatome?
Above/across the knee (and just proximal to the kneecap)
How is an adductor muscle test performed for an L3 MRS?
Patient is side-lying. Doctor stands behind patient, lifts and supports the top leg and pushes bottom leg into abduction contacting just below the knee (try to break legs apart while patient brings in)
The periosteum is highly innervated by nociceptors (TRUE/FALSE)?
t
What muscle is tested first for an L4 MRS?
Tibialis anterior
What is the reflex for an L4 MRS?
Patellar tendon
Where is the L4 dermatome?
Medial leg to behind the ankle and into the arch of the foot to the medial aspect of the big toe
How is a muscle test for tibialis anterior for an L4 MRS performed?
Placement of the foot is up and in and the doctor pulls foot down and out
How is a muscle test for the quadriceps for an L4 MRS performed?
Patient seated. Knee is extended to 120 degrees. Doctor attempts to flex the knee against resistance.
What muscle is tested first for an L5 MRS?
Extensor hallicus longus/brevis
How is an extensor hallicus longus and brevis test for an L5 MRS performed?
Place 1st digit into flexion, doctor uses index and middle finger to push straight down across the entire dorsal surface of the patients toe
What reflex is tested first for an L5 MRS?
Medial hamstring tendon
How is an extensor digitorum test for an L5 MRS performed?
Place toes into extension and have doctor push toes down
How is an abductor muscle group test for an L5 MRS performed?
Patient is side-lying, doctor presses top leg into adduction stabilizing above the iliac crest
What is the secondary muscle test for the L4 MRS?
Quadriceps
What is the action of the quadriceps?
Hip flexion and knee extension
Neurogenic claudication is dependent on ________________?
Position
Vascular claudication is dependent on __________________?
Movement
What form of claudication is better with rest and time dependent?
Vascular
What form of claudication is caused by canal stenosis?
Neurogenic
Patient has pain that is better going up the stairs and worse going down the stairs. What is this a classic sign of?
Canal stenosis causing neurogenic claudication
If a patient performs a bicycle test and still has pain what type of claudication is indicated?
Vascular
If a patient performs a bicycle test and their pain gets better what type of claudication is indicated?
Neurogenic
What muscle is tested first for an S1 MRS?
Fibularis longus/brevis
What is the reflex for an S1 MRS?
Achilles tendon
Where is the dermatome for S1?
Lateral aspect of foot
What is the main function of extensor hallicus longus and brevis?
Extend/dorsiflexion of big toe
What is the main function of tibialis anterior?
Foot dorsiflexion
What alternate reflex besides the Achilles’ tendon is available for an S1 MRS?
Lateral hamstring tendon
How is a peroneus longus and brevis muscle test performed for an S1 MRS?
Place foot down and out as doctor pulls up and in
How is a gastrocnemius test for an S1 MRS performed?
Patient prone with knee extended and foot in neutral. Dr tries to resist patient pushing into plantar flexion
How is a soleus test for an S1 MRS performed?
Same is gastrocnemius but the knee is bent to 90 degrees
L4/L5 nerve roots primarily function in what action?
Foot dorsiflexion
What is the secondary muscle test for an L5 MRS?
Extensor digitorum
What is the tertiary muscle test for an L5 MRS?
Hip abductors
How is a gluteus maximus muscle test performed for an S1 MRS?
Patient prone and knee is flexed to 90 degrees and hip extended. Doctor stabilizes above the iliac crest and resists extension.
Where does peroneus longus insert?
Base of 1st metatarsal (wraps around under the foot)
What is the secondary muscle test for an S1 MRS?
Gastrocnemius/soleus
What is the tertiary muscle test for an S1 MRS?
Gluteus maximus
What is the most distal muscle that we can test for an S1 MRS?
Fibularis longus and brevis
The patellar reflex is a secondary reflex for what nerve roots?
L2-L3
The patellar reflex is a PRIMARY reflex for what nerve root?
L4
What is the reflex test for L5?
Medial hamstring
What are the grades for the Wexler REFLEX grading scale?
+5 = Hyperreflexia + Sustained clonus
+4 = Hyperreflexia + Transient clonus
+3 = Hyperreflexia
+2 = Normal
+1 = Hyporeflexia
+0J = Absent
What must be performed if a patient scores a 0+ on a Wexler grading scale?
Jendrassik maneuver
What are the grades for a Wexler MUSCLE grading scale?
5 = Normal; Full ROM against gravity with FULL resistance
4 = Good; Full ROM against gravity with SOME resistance
3 = Fair; Complete ROM against gravity ONLY
2 = Poor; Complete ROM with gravity ELIMINATED
1 = Trace; Slight contractility with NO JOINT MOTION
0 = NO CONTRACTILITY
L3 sensory
Above the knee
S1 sensory
On the bun(ion)
L5 sensory
On the side
What is the sensory MRS for the L5 nerve root?
Lateral leg in front of the lateral malleolus and across to the web of the foot between tarsals 1-2
