Neurological Evaluation

 

Definitions

Radiculopathy

Weakness in 2 or more muscles of same myotome, different intermediate nerves, with normal adjacent myotomes.  Reflex changes in appropriate myotome.  Sensory deficit in appropriate dermatome.

 

Mononeuropathy

Weakness in muscles all innervated by the same nerve.  Appropriate reflex changes.  Sensory deficit in peripheral nerve pattern.

 

Mononeuritis Multiplex

Lesion of 2 or more non-contiguous nerves (eg. right radial neuropathy, left peroneal neuropathy)

 

Polyneuropathy

Involvement of many nerves.  Can be sensory, motor or both.  Can be symmetric or asymmetric.  Usually distal, can be proximal.

 

C5 without C6:

Rhomboids: C4, C5, Dorsal scapular nerve/arm behind back, push down

 

Strongly C5: (C6)

Serratus Anterior: C5,C6,C7 directly from roots/scapular winging

Deltoids: C5, C6, UT, PD, PC axillary n

Supraspinatus: C5, C6, UT, suprascapular nerve/Abduct arm from side

Infraspinatus: C5, C6, UT suprascapular nerve/Externally rotate humerus

Biceps: C5, C6, UT, AD, LC, Musculocutaneous nerve

Brachioradialis: C5, C6, UT, PD, PC, Radial nerve/Palm vertical to floor, flex forearm at elbow

 

C6 without C5:

Triceps: C5, C6, C8, UT-MT-LT, PD, PC, Radial nerve

Pronator Teres: C6, C7, UT,MT, AD, LC, Median nerve

Supinator: C6, C7, UT-MT, PD, PC, Radial nerve

Flexor carpi radialis: C6, C7, UT-MT, AD, LC, Median nerve

 

C7 without C6:

Extensor Carpi Ulnaris: C7, C8, MT-LT, PD, PC, Radial nerve, PION branch

(All finger extensors, including thumb)

Extensor Digitorum: C7, C8, MT-LT, PD, PC, Radial nerve, PION branch

Ext Pollicis: c7, C8, MT-LT, PD, PC, Radial nerve, PION branch/Hitchhike

Flexor Poll Longus: C7, C8, MT-LT, LC-MC, Median nerve, AION branch/Fix prox phalanx, flex distal phalanx

FDP 1+2: C7, C8, MT-LT, LC-MC, Median nerve, AION branch, Flex index and middle finger at DIP

FDP 3,4: C7, C8, MT-LT, AD, MC, Ulnar nerve/Flex ring and little finger at DIP

 

C8 without C&: (Hand intrinsics)

APB: C8, T1, LT, AD, MC, Median nerve/Abduct thumb (right angle to palm), feel muscle belly. (CTS)

Opponents Poll: C8, T1, LT, AD, MC, Medial head, Median nerve/Touch base of little finger with thumb. (CTS)

FCU: C7, C8, T1, MT-LT, AD, MC, Ulnar nerve/Flex, Ulnar deviate wrist

Abductor dig quinti or minimi: C8, T1 LT, AD, MC, Ulnar nerve/Abduct little finger

Flexor Dig Minimi: C8, T1, LT, AD, MC, Ulnar nerve/Flex little finger at MCP joint with 2nd, 3rd, and 4th fingers held flat on table

FDI: C8, T1, LT, AD, MC, Ulnar nerve

Adductor Poll: C8, T1, LT, AD, MC, Ulnar nerve/Adduct thumb at right angle to palm

 

Reflexes:

Biceps                                   C5-C6 (mostly C5)

Brachioradialis:                   C5-C6 (mostly C6): Tap radial styloid process.  Arm should flex, supinate slightly.

Triceps                                  C6-C7-C8 (mostly C7)

Finger Flexors                      C7-C8-T1 (mostly C8)

 

"Inverted" Brachioradialis Reflex: Tap the radial styloid process

No flexion of forearm or supination-C5-6 root lesion (LMN lesion-arreflexia)

Get flexion of fingers-Corticospinal tract lesion-UMN to C7, C8, T1 (hyperreflexia)

Indicates a myelopathy or myelopathy/radiculpathy at C5 or C6