In the lab do the following:

a. Evaluate the C4, C5, C6 nerve roots with SMR exam

E.g.

Shoulder Abduction C5 myotome

Scapular Adduction C4 Myotome
Elbow Flexion C6 myotome
Forearm pronation C6 myotome
Forearm supination C7 myotome
Wrist Extension C6 myotome
Sensation (top of C4 dermatome
shoulder)
Sensation (lateral C5 dermatome
brachium)
Sensation lateral 2 fingers C6 dermatome
Reflex (biceps) C5 reflex
Reflex (brachioradialis) C6 reflex

b. Evaluate the C7, C8 and T1 nerve roots with SMR exam

e.g.

Triceps C7-C8
Wrist flexion C7 myotome
Finger Extension C7 myotome
Thumb Abduction C8- T1 myotome
Finger Abduction T1 myotome
Sensation (middle finger) C7 dermatome
Sensation (antebrachium) C8 dermatome
Sensation (medial elbow) T1 dermatome
Reflex (triceps) C7 reflex
 c. Evaluate the C1, C2, C3 and C4 nerve roots (more challenging)
e.g.

Neck Flexion C1-C6 myotome

Neck Extension C1- T1 myotome
Shoulder Shrug C3- C5 myotome
Greater Occipital C2 dermatome
sensation
Lesser Occipital C2- C3 dermatome
sensation
Greater Auricular C3- C3 dermatome
Supraclavicular C3- C4 dermatome

Study Guide Questions: 2.4

1. What does the mnemonic ‘LODCTRRAPPA” stand for? When is it used?

- Location: specific location of the problem

- Onset: onset of the mechanism of injury
- Duration: how long has it been there for?
- Course: better, worse, the same
- Type of pain
- Radiation
- Relieving factors
- Aggravating factors
- Previous episode
- Previous treatment
- Associated signs and symptoms

This mnemonic is used when taking the history of a patient.

2. Describe what is meant by a system’s review.

A review of the body systems such as cardiovascular, respiratory, GI etc.
3. What does VIPPIRONEL stand for? When is it used?

- Vitals
 - Inspection (posture, gait, alertness)
- Palpation
- Percussion
- Instrumentation
- Ranges of motion
- Orthopaedic tests
- Neurological tests
- Extra studies (x-ray, CT, MRI)
- Lab studies

This is used as steps for a patient examination

4. Describe the difference between dermatomes, sclerotomes and myotomes.

Myotomes are a group of muscles innervated by the motor compartment of a
single spinal nerve root, dermatomes are the skin area supplied by the sensory
component of a single nerve root a sclerotome form vertebrae and ribs.

5. Describe the differences between nerve root pressure and nerve trunk pressure.
Nerve root: pain, paranesthesia, numbness, segmental distribution of symptoms,
chronological sequence of symptoms. Compression phenomenon: the pins and
needles appear during compression
Nerve trunk: paranesthesia, numbness, pain, vaguely delineated area. Release
phenomenon: the pins and needles appear after the compression has ceased.
6. Describe the differences between spinal cord pressure and peripheral nerve
pressure.
Peripheral nerves: numbness, paresthesia, pain, clearly delineated area
Spinal cord: completely painless (sometimes dural pain), extra segmentally and
bilaterally distributed paranesthesia, positive neck flexion

7. What are tension signs?

8. Describe what you would find in a typical feature of irritation of the C5

nerve root.

- Sensory loss of the deltoid/bicep region

9. What spinal nerve has no dermatome associated with it?

- C1 has no dermatome

10. Dermatomes, sclerotomes and myotomes are derived from embryological

structures?

- Dermatomes: form connective tissue and skin

- Myotomes: form skeletal muscles of neck, trunk and limbs
- Sclerotomes: form vertebrae and ribs

11. Between which two vertebrae does the spinal nerve C7 exit the intervertebral
foramen (IVF)?

- Exits between C6 and C7

12. Which choice best describes C7 muscle test, Deep tendon reflex and sensory
testing?

a) finger abduction, pectoralis deep tendon reflex, and medial upper

arm sensory from the elbow to the axilla
b) wrist extension, brachial radialis deep tendon reflex, and lateral
forearm and digits 1 and 2 sensory from the elbow to the tip of the
fingers
c) wrist flexion, triceps deep tendon reflex, and anterior and
 posterior middle finger sensory from the wrist to the tip
d) shoulder abduction, biceps deep tendon reflex, and lateral upper
arm sensory from the shoulder to the elbow.

13. 25-year-old AFL player fell on his shoulder vertically and violently
stretched his neck in the opposite direction. He was later diagnosed with
a brachial plexus injury. His arm is hanging at his side in medial rotation
in the ‘waiter’s tip” position. What results are expected from the
neurological examination?

a) Paralysis of the deltoid, triceps, wrist extensors (long and short carpi
radialis) and finger extensors
b) Paralysis of all intrinsic muscles of the hand, flexor muscles (claw
hand), loss of sensation over C8-T1 dermatomes and Horner’s
syndrome
c) Hypaesthesia over C5-C6 and weakness of the deltoid,
supraspinatus and infraspinatus, biceps and brachioradialis muscle
d) Klumpke paralysis caused by forced hyperabduction of the arm