Neurological Testing

Question 0

How many spinal nerves?

Answer 0

8 cervical
12 thoracic
5 lumbar
5 sacral

= 30

Question 1

What do neurological tests evaluate?

Answer 1

Afferent (from CNS) and efferent (to CNS) impulses, and their integration.

Question 2

Dermatome

Answer 2

A skin area innervated by the sensory fibres of a single nerve root.

Pain in a dermatome may indicate spinal damage or neurological stenosis

Question 3

Stenosis

Answer 3

Abnormal narrowing in blood vessel or other tubular organ or structure.

Question 4

Peripheral nerve field

Answer 4

Similar to dermatome but innervated by peripheral nerves instead or dorsal root.

Question 5

What are the cervical level dermatomes?

Answer 5

C1 top of cranium 
C2 posterior/lateral head/occiput
C3 lateral neck
C4 upper traps, AC joint
C5 over deltoid
C6 thumb/radial side of wrist 
C7 posterior forearm to tip of middle finger 
C8 tip of little finger/ulnar side of wrist
T1 medial elbow.

Question 6

What are the spinal level dermatomes?

Answer 6

L1 inguinal area
L2 upper 1/3 anterior thigh
L3 medial knee
L4 lateral knee to medial malleolus
L5 lateral low leg to dorsum of big toe
S1 heel/lateral foot.

Question 7

Myotomes

Answer 7

Group of muscles primarily innervates by motor fibres of a single nerve.

Question 8

Cervical spine myotomes

Answer 8

C1/C2  neck flexion
C3 lateral flexion of neck 
C4 shoulder shrug
C5 arm abduction
C6 elbow flexion/wrist extension (waiter wrist)
C7 elbow extension/wrist flexion
C8 thumb extension 
T1 finger abduction/adduction

Question 9

Spinal level myotomes

Answer 9

L1 none
L2 hip flexion
L3 knee extension
L4 ankle dorsiflexion
L5 extension of big tow
S1 plantar flexion/ eversion.

Question 10

Deep tendon reflexes

Answer 10

Assess functioning of nerve or nerve root supplying reflex.

Caused by stretching muscle spindle, which synapses through sensory neurons to spinal cord and back through motor neurons, contracting muscle.

Question 11

If tendon reflex absent ..

Answer 11

… may be indication of spinal cord, nerve root, peripheral nerve, or muscle has been damaged.

Question 12

If tendon reflex abnormal …

Answer 12

… May be due to disruption of sensory or motor nerves (or both).

Question 13

Clonus

Answer 13

Repetitive vibratory contraction of the muscle that occurs in response to muscle stretch.

Question 14

Tendon reflex scale

Answer 14

0 absent
1+ trace
2+ normal
3+ brisk
4+ non sustained clonus
5+ sustained clonus

Question 15

Normal tendon reflex score

Answer 15

1+ to 3+ unless asymmetric, or dramatic difference between arms and legs.

Question 16

Signs of hyperreflexia

Answer 16

Clonus
Spreading of reflexes to untested muscles
Crossed adduction of opposite leg when medial knee tapped.

(Associated with upper motor neuron lesions)

Question 17

What factors can affect deep tendons reflexes?

Answer 17

Age
Electrolyte balance
Thyroid dysfunction 
Metabolic factors 
Anxiety

Question 18

Main spinal nerve roots involved in feel tendon reflexes

Answer 18

Biceps.  C5/C6
Brachioradialis. C6
Triceps c7
Patellar L4
Medial hammies L5
Achilles s1