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Orthopaedic Neurology

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Title: Orthopaedic Neurology Author: User Last modified by: Michael Created Date: 12/8/2003 5:02:11 AM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Title: 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 neurons
    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
12
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13
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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
23
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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
29
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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
38
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39
Flexor Digitorum Superficialis (Left), and
Profundus (Right)
40
Lumbricales
41
Muscle Test Finger Flexors
42
Memory Trick
43
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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
51
Herniated Cervical Disc
52
Occiput C1 Articulation
53
C1 and C2 Articulation
54
Anatomic Basis for Posterior Cervical Disc
Herniation
55
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56
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57
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58
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59
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60
Neurologic Levels in Upper Extremity
  • Motor
  • C5 shoulder abduction
  • C6 wrist extension
  • C7 wrist flexion and finger extension
  • C8 finger flexion
  • T1 finger abduction, adduction

61
Neurologic Levels in Upper Extremity
  • Sensation
  • C5 lateral arm
  • C6 lateral forearm, thumb, and index finger
  • C7 middle finger (variable)
  • C8 medial forearm, ring, and small finger
  • T1 medial arm
  • T2 - Axilla

62
Neurologic Levels in Upper Extremity
  • Reflex
  • C5 biceps
  • C6 Brachioradialis
  • C7 - triceps

63
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64
Whiplash Injury to the Cervical Spine
65
Anatomy of a Cervical Vertebrae
66
Orthopedic Tests Cervical Spine
  • Valsalva test
  • Distraction test
  • Compression test

67
Valsalva Test
68
Distraction Test
69
Compression Test
70
Thoracic Spine
71
Beevors Spine
72
Hip Flexion
73
Iliopsoas
74
Muscle Test Iliopsoas
75
Knee Extension
76
Rectus Femoris (Left), Vastus Intermedius and
Lateralis (Right)
77
Extension Lag
78
Muscle Test Quadriceps
79
Hip Adduction
80
Adductors
81
Muscle Test Hip Adductors
82
Dermatomes of the Lower Extremity
83
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84
Foot Inversion
85
Muscle Test Tibialis Anterior
86
Patellar Tendon Reflex
87
Memory Trick
88
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89
Foot Dorsiflexion (Ankle Extension)
90
Extensor Hallucis Longus
91
Muscle Test Extensor Hallucis Longus
92
Muscle Test Toe Extensors
93
Memory Trick
94
Hip Abduction
95
Gluteus Medius
96
Muscle Test Gluteus Medius
97
L5 Sensory Dermatome
98
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99
Foot Eversion
100
Peroneus Longus Brevis
101
Muscle Test Peronei Muscles
102
Foot Plantarflexion
103
Gastrocnemius Soleus
104
Muscle Test Gastrocnemius
105
Hip Extension
106
Gluteus Maximus
107
Muscle Test Gluteus Maximus
108
Achilles Reflex Test
109
Memory Trick
110
Sensory Dermatomes S2, S3, S4, S5
111
Sensory Dermatomes L4-S1
112
Testing Sensation
113
Anatomic Basis for Posterior Lumbar Disc
Herniation
114
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115
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116
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117
Neurologic Levels in Lower Extremity
  • Motor
  • L3 quadriceps (L2, L3, L4)
  • L4 Tibialis anterior
  • L5 toe extensors
  • S1 - Peronei

118
Neurologic Levels in Lower Extremity
  • Sensation
  • T12 lower abdomen just proximal to inguinal
    ligament
  • L1 upper thigh just distal to inguinal ligament
  • L2 mid thigh
  • L3 lower thigh
  • L4 medial leg medial side of foot
  • L5 lateral leg dorsum of foot
  • S1 lateral side of foot
  • S2 longitudinal strip, posterior thigh

119
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120
Neurologic Levels in Lower Extremity
  • Reflex
  • L4 patellar
  • L5 Tibialis posterior (difficult to obtain)
  • S1 Achilles tendon
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