NERVE ROOTS

Question 1

Explain the “Initial Examination Procedure” of testing nerve roots:

Answer 1

“This is my pinwheel, it’s pointy and prickly and feels something like this, is that ok?”

1. C4 on right compared to C4 on left (dermatome above)
2. C5 on right compared to C5 on left (dermatome package)
3. C6 on right compared to C6 on the left (dermatome below)

Question 2

Explain the Secondary Examination Procedure with nerve roots:

Answer 2

FIRST

1. C4 on the right side compared to C5 on the right side
2. C5 of right side compared to C6 of right side

SECOND

1. C4 of left side compared to C5 of left side
2. C5 of left side compared to C6 of left side

“Can you feel this? AND does it feel like this?

Question 3

C5 NERVE ROOT

Answer 3

• DISC LEVEL: C4
• MUSCLE TESTS (2):
  
  1. Shoulder Abduction: Deltoid (axillary nerve)
  2. Forearm Flexion: Biceps (musculocutaneous nerve)
• REFLEX: Biceps
• SENSATION: Lateral Arm

Question 4

C6 NERVE ROOT

Answer 4

• DISC LEVEL: C5
• MUSCLE TEST (1):
  
  1. Wrist Extension: Extensor carpi radialis longus and brevis, and extensor carpi ulnaris (radial nerve)
• REFLEX: Brachioradialis
• SENSATION: Anterior Lateral Forearm, palm, thumb, and 2nd digit

Question 5

C7 NERVE ROOT

Answer 5

• DISC LEVEL: C6
• MUSCLE TESTS (3):
  
  1. Elbow Extension: Triceps (Radial Nerve)
  2. Wrist Flexion: Flexor carpi radialis (Median Nerve), Flexor ulnaris (ulnar nerve)
  3. Finger Extension: Extensor digitorum communis, extensor indicis profundus, extensor digiti minimi (Radial nerve)
• REFLEX: Triceps
• SENSATION: 3rd digit, middle of palm

Question 6

C8 NERVE ROOT

Answer 6

• DISC LEVEL: C7
• MUSCLE TEST (1):
  
  1. Finger Flexion: Flexor digitorum superficialis, flexor digitorum profundus, lumbricals (median and ulnar nerves)
• REFLEX: NONE*
• SENSATION: 4th and 5th digits, antero-medial hand and forearm

Question 7

T1 NERVE ROOT

Answer 7

• DISC LEVEL: T1
• MUSCLE TESTS (2):
  
  1. Finger Abduction: Dorsal Interossei (ulnar nerve)
  2. Finger Adduction: Palmer Interossei (ulnar nerve)
• REFLEX: NONE**
• SENSATION: Antero-medial arm (distal aspect of arm to proximal aspect of forearm)

Question 8

L4 NERVE ROOT

Answer 8

• DISC LEVEL: L3
• MUSCLE TEST (1):
  
  1. Foot Dorsiflexion and Inversion: Tibialis Anterior (deep fibular/peroneal nerve)
• REFLEX: Patellar Tendon
• SENSATION: Medial aspect of leg, medial foot, medial aspect of big toe

Question 9

L5 NERVE ROOT

Answer 9

• DISC LEVEL: L4
• MUSCLE TESTS (4):
  
  1. Foot Dorsiflexion: Gastrocnemius, Soleus
  2. Big Toe Dorsiflexion: Extensor hallucis longus (deep fibular/peroneal nerve)
  3. Toes 2, 3, 4 dorsiflexion: Extensor digitorum longus and brevis (deep fibular/peroneal nerve)
  4. Hip and Pelvis Abduction: Gluteus medius and minimus (superior gluteal nerve)
• REFLEX: NONE*
• SENSATION: Lateral leg, dorsum of foot, and middle third toes

Question 10

S1 NERVE ROOT

Answer 10

• DISC LEVEL: L5
• MUSCLE TESTS (3):
  
  1. Foot Plantarflexion: Gastrocnemius and Soleus (Tibial Nerve)
  2. Foot Plantar Flexion and Eversion: fibular/peroneus longus and brevis (superficial fibular/peroneal nerve)
  3. Hip Extension: Gluteus Maximus (Inferior gluteal nerve)
• REFLEX: Achilles
• SENSATION: Posterior aspect of the leg, lateral aspect of foot, and lateral aspect of little toe

Question 11

S2 NERVE ROOT

Answer 11

• DISC LEVEL: S1
• SENSATION: Posterior aspect of thigh over popliteal fossa on to posterior medial calf