Orthopaedic Neurology

1. Orthopaedic Neurology Diagnostic Guide to Neurological Levels

2. Motor Power • Interruption of the nerve root causes denervation and paralysis of its myotome. • Pressure on a nerve root can cause a decrease in muscle strength. • Muscle testing is utilized to evaluate whether or not a lesion is present and to what degree it is effecting the muscle strength.

3. Muscle Grading Chart • Muscle gradations • 5 – normal • 4 – good • 3 – fair • 2 – poor • 1 – trace • 0 - zero • Description. • Complete range of motion against gravity with full resistance. • Complete range of motion against gravity with some resistance. • Complete range of motion against gravity. • Complete range of motion with gravity eliminated. • Evidence of slight contractility. No joint motion. • No evidence of contractility.

4. Sensation • Pathology to the cord or nerve root results in loss of light touch, followed by loss of sensation of pain. • During recovery from nerve root injury, sensation of pain returns before light touch.

5. Sensation • The 2 sensations are tested separately, light touch with a cotton swab, pain with pinpricks. • Pinwheels can be utilized to evaluate sensation. • Results can be recorded on a dermatome chart as normal, hyperesthetic (increased), hypoesthetic (decreased), dyesthetic (altered), or anesthetic (absent).

6. Reflex • Interruption in the basic reflex arc results in the loss of reflex, while pressures on the nerve root itself may decrease its intensity (hyporeflexia). • Interruption of the upper motor neuron’s regulatory control results in a hyperactive nerve (hyperreflexia). • Reflexes should be reported as normal, increased, or decreased utilizing bilateral comparison.

7. Stretch Reflex Arc

8. Nerve Root Lesions by Neurologic Level

9. Evaluation of Nerve Root Lesions Upper Extremity

10. Cervical Spine • C5 is the 1st significant contribution to the brachial plexus. • C1-4 are difficult to test; However, C4 is the major innervation to the diaphragm (via the phrenic nerve).

11. The Cervical Spine

14. Deltoid & Supraspinatous

15. Elbow Flexion and Extension

16. Biceps Brachii & Brachialis

17. Functions of the Biceps

18. Muscle Test for the Biceps

19. Biceps Reflex Test

20. Memory Trick

21. Muscle Test Shoulder Abduction

22. Sensory Distribution C5

24. Wrist Extension and Flexion

25. Extensor Carpi Ulnaris (Left), Extensor Carpi Radialis (Right)

26. Muscle Test Wrist Extension

27. Brachioradialis Reflex Test

28. Memory Trick

30. Triceps Brachii

31. Walking With a Crutch Utilizes the Triceps Muscle

32. Muscle Test Wrist Flexors

33. Flexor Carpi Radialis (Left), Flexor Carpi Ulnaris (Right)

34. Finger Extension and Flexion

35. Extensor Digitorum

36. Muscle Test Finger Extension

37. Triceps Reflex Test

39. Flexor Digitorum Superficialis (Left), and Profundus (Right)

40. Lumbricales

41. Muscle Test Finger Flexors

42. Memory Trick

44. Finger Abduction and Adduction

45. Muscle Test Finger Abduction

46. Muscle Test Finger Adduction

47. Summary of Muscle Testing for the Upper Extremity

48. Summary of Reflex Testing for the Upper Extremity

49. Summary of Sensation for the Upper Extremity

50. Cervical Vertebrae and Nerve Roots