Lecture 6 - Neurological Scan Exam

Question 1

Neurological scan exam purpose:

Answer 1

Rule out serious pathology

Determine if a neural component is involved

Clears neurological structures

Question 2

When to do neurological exam:

Answer 2

Referred pain

Muscle weakness without pain

Tingling, numbness

Spinal pain

Question 3

neurological scan exam helps to determine:

Answer 3

whether the pathology is caused by

• nerve root
• peripheral nerve

Question 4

with neurological scan exams you must be able to differentiate:

Answer 4

A dermatome (nerve root) from the sensory distribution of a peripheral nerve

A myotome (nerve root) from muscles supplied by a specific peripheral nerve

Question 5

How many nerve root pairs are there? Where are they located?

Answer 5

31 nerve root pairs

8 cervical

12 thoracic

5 lumbar

5 sacral

1 coccygeal

Question 6

Define dermatome

Answer 6

Area of skin supplied by a single nerve root

Question 7

define myotome

Answer 7

Groups of muscles supplied by a single nerve root

• Isometric contraction for at least 5 seconds
• Repeat at least 6 times

Question 8

define sclerotome

Answer 8

Area of bone or fascia supplied by a single nerve root

Question 9

A segmental nerve has what components

Answer 9

Segmental nerve has a motor, sensory, and autonomic component

Question 10

A facilitated segment is an area of increased irritation produced by skin, muscle, nerve, periosteum, ligament or tendon which produces an ___ response

Answer 10

afferent

Question 11

An efferent reaction may be:

Answer 11

Sensory
-pins and needles

Motor

• muscle spasm
• trigger points
• weakness

ANS
-circulatory, perspiration, reflex, goose bumps, increased skin drag, skin pitting

Neurological deficits are not all or none

Question 12

The first neurological change is fading of the response

Test myotomes and reflexes _ times in a row to see if the response fades

Hold for _ seconds

Fatigue indicates a facilitated segment at that _____ level

Answer 12

The first neurological change is fading of the response

Test myotomes and reflexes 6 times in a row to see if the response fades

Hold for 5 seconds

Fatigue indicates a facilitated segment at that vertebral level

Question 13

The individual nerve roots are examined by testing;

Answer 13

Dermatome
Myotome
Reflexes

Nerve root compression is involved when all three are positive and may be involved if one or two tests are positive

Question 14

Nerve root testing dermatome:

Answer 14

Segmental innervation of the skin supplied by one spinal root

Testing for altered sensation

Dermatomes vary

Positive dermatome test
-Patient does not feel the sharpness of the pin or pinwheel in one dermatome

C4 – S2 key test sites

• Above or below these areas provide a challenge
• C4 important cause phrenic nerve which innervates diaphram to stimulate breathing

Question 15

Nerve root testing dermatomes upper quadrant:

Answer 15

C4 – lateral neck
C5 – shoulder cap
C6 – thumb or thumb to 2nd finger interspace
C7 – middle finger
C8 – lateral edge of little finger
T1 – inner forearm
T2 – arm pit

Question 16

Nerve root testing dermatomes lower quadrant:

Answer 16

L3 – over knee
L4 – below medial malleolus
L5 – in web between 1st and 2nd toe
S1 – below lateral malleolus
S2 – sole and heel of the foot

Question 17

Nerve root testing myotomes:

Answer 17

Segmental innervation of the muscle

Test key muscles for weakness or pain

Isometric test repeated 6 times, hold for 5 seconds

Pain and weakness on contraction

Question 18

Nerve root testing myotomes upper quadrant:

Answer 18

C1 
-head nodding of occiput on atlas (test tucking in chin)
C2 
-neck rotation of C1-C2
C3 
-lateral flexion of the neck
C4 
-shoulder shrug
-diaphragm and its ability to lower
C5 
shoulder abduction, elbow flexion
C6 
elbow flexion, wrist extension, elbow supination
C7 
elbow extension, wrist flexion
C8 
thumb extension
T1 
finger abduction

Question 19

nerve root testing myotomes lower quadrant:

Answer 19

L2 – hip flexion
L3 – knee extension
L4 – dorsiflexion
L5 – great toe extension, ankle eversion, extension of all four toes
S1 – ankle plantar flexors, up and down on toes, great toe flexion
S2 – resisted knee flexion

Question 20

reflexes upper quadrant:

Answer 20

C5-C6 – biceps jerk

C6 – brachioradialis jerk

C6-C7 – triceps jerk

Question 21

reflexes lower quadrant:

Answer 21

L3-L4 – knee jerk

L5-S1 – achilles jerk

L5 – extensor digitorum brevis jerk
Tap on bulge on lateral side of foot
Minimal movement expected not very strong reflex

Question 22

nerve root testing scleratome:

Answer 22

Areas of bone that are supplied by one nerve root

Not tested but be aware of bone tenderness

Question 23

Describe visceral and somatic convergence

Answer 23

Each spinal root has autonomic fibres which innervate visceral organs and smooth muscle of the blood vessels

Nerve root compression can cause visceral and vascular changes
Facilitated segments

*Remember nerve roots have a somatic and visceral innervations

Question 24

What is a nerve root?

Answer 24

A nerve root is a portion of the peripheral nerve that connects the nerve to the spinal cord
- Single nerve root may serve more than 1 peripheral nerve e.g. median nerve c6, c7, c8 ,t1