Presentation on theme: "Orthopaedic Neurology"— Presentation transcript:
1Orthopaedic Neurology Diagnostic Guide to Neurological Levels
2Motor PowerInterruption 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.
3Muscle Grading Chart Muscle gradations Description. 5 – normal4 – good3 – fair2 – poor1 – trace0 - zeroDescription.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.
4SensationPathology 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.
5SensationThe 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), hyposthetic (decreased), dyesthetic (altered), or anesthetic (absent).
6ReflexInterruption 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.
117Neurologic Levels in Lower Extremity MotorL3 – quadriceps (L2, L3, L4)L4 – Tibialis anteriorL5 – toe extensorsS1 - Peronei
118Neurologic Levels in Lower Extremity SensationT12 – lower abdomen just proximal to inguinal ligamentL1 – upper thigh just distal to inguinal ligamentL2 – mid thighL3 – lower thighL4 – medial leg – medial side of footL5 – lateral leg – dorsum of footS1 – lateral side of footS2 – longitudinal strip, posterior thigh