Screening: Myotomes, Dermatomes, and Reflexes Flashcards
When is it necessary to perform an entire body muscle test
- Guillain-Barre Syndrome
- Incomplete spinal cord injury
When would you choose a “make” test over a “break” test
- when you want to check that the strength is equal in both extremities
When would you choose to avoid strength testing
- fracture
- extremely painful
- known tear
Contraindications for strength testing
- unhealed fracture
- pathologically unstable joints
- prohibited AROM
Precautions for strength testing
- advanced osteoporosis
- metastatic cancer
- osteogenesis imperfecta
How does Cyriax’s method (contractile unit testing) add to your assessment
Strong & pain free: nothing is wrong with contractile tissue
Strong & painful: inflammation not a complete tear
Weak & painful: partial tear
Weak & pain free: complete tear
What are the general “rules of thumb” for strength testing
- minimize position changes
- encourage good postural alignment
- test unaffected side first then the affected side
- if weakness is noted, ask patient to describe the difficulty holding the test position
What sensations do the dorsal column tract and the spinothamlamic tract carry
Dorsal Column: light touch, vibration, joint position, & discriminative sensation
Spinothalamic: coarse touch, temperature, & pain sensation
What does glove & stocking distribution sensory loss indicate
- neuropathy
Purpose of testing joint position sense
- to determine if patient can identify “up” or “down” position of a joint
Define stereognosis discriminative sensation test
- place a familiar object in patient’s hand (coin, key, paper clip)
- ask patient to identify object
- begin on unaffected side first
Define graphesthesia discriminative sensation test
- draw large number on patient’s extremity
- identify top/bottom of drawing area first
Define two point discrimination discriminative sensation test
- use 2 point discrimination tool of bent paper clip
- 5mm is normal for pads of fingers
Define point localization discriminative sensation test
- have patient close eyes
- touch patient on distal extremity
- have patient open eyes & point to the location that you touched
- start with unaffected side first
- move distal to proximal, as indicated
When is it a priority to test somatosensory function
- symptoms consistent with nervous system involvement
- conditions that impair distal sensation
- dysfunction at a nerve root level
When is it pointless to test somatosensory function
- no condition that affects the nervous system, symptoms of somatosensory involvement, or risk factors for somatosensory loss
When is it a priority to test dermatomes & myotomes
- signs & symptoms suggest nerve root pathology
- differentiate between nerve root dysfunction & peripheral nerve injury
- presence of sensory or motor function at nerve root levels surrounding spinal cord injury
- integrity of peripheral nervous system
When is it pointless to test dermatomes & myotomes
- conditions unrelated to spinal nerve root pathology
What are the upper quarter reflexes
- biceps tendon
- triceps tendon
- brachioradialis
- hoffman
- clonus
What are the lower quarter reflexes
-patellar tendon
- achilles tendon
- babinski
- clonus
What outcomes of a deep tendon reflex signify a lower motor neuron lesion
- hyporeflexia
What outcomes of a deep tendon reflex signify an upper motor neuron lesion
- hyperreflexia
Deep tendon reflex rating system
0: No reflex
1+: minimal or depressed response
2+: normal response
3+: overly brisk response
4+: extremely brisk response with clonus
What nerve root is tested with biceps, triceps, brachioradialis, patellar, & achilles deep tendon reflexes
Biceps: C5
Triceps: C7
Brachioradialis: C6
Patellar: L4
Achilles: S1
