Presentation on theme: "Orthopaedic Neurology Diagnostic Guide to Neurological Levels."— Presentation transcript:
Orthopaedic Neurology Diagnostic Guide to Neurological Levels
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.
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.
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.
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), hyposthetic (decreased), dyesthetic (altered), or anesthetic (absent).
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.
Stretch Reflex Arc
Nerve Root Lesions by Neurologic Level
Evaluation of Nerve Root Lesions Upper Extremity
Cervical Spine C5 is the 1 st 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).