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LECTURE
BASIC PERIPHERAL NERVE
EXAMINATION
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I WAYA N A R YA N TA P U T R A

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BASICS
• Bundles of nerve fibers found in the CNS are referred to as nerve tracts; bundles of nerve
fibers found in the PNS are called peripheral nerves.
• The formation of a nerve plexus allows individual nerve fibers to pass from one
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peripheral nerve to another.

• The cervical and brachial plexuses are at the root of the upper limbs; the lumbar and
sacral plexuses are at the root of the lower limbs.

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OUTLINE

Upper Limb
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Trunk

Lower Limb
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UPPER LIMB
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ANATOMY AND PHYSIOLOGY

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CERVICAL PLEXUS
The cervical plexus has 4 cutaneous
branches:
• The great auricular (C2-3) supplies skin
over the angle of the mandible, parotid,
mastoid, and auricle.
• Lesser occipital (C2-3) supplies the
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lateral part of the occiput and medial

surface of the auricle.
• Supraclavicular (C3-4).
• The transverse cervical nerve (C2-3)
supplies skin over the anterior and lateral
neck from the mandible to the sternum.

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BRACHIAL PLEXUS
The brachial plexus forms from the ventral
rami of C5-8 and T1:
• C5 and C6 ventral rami join to form the
superior trunk.
• C7 ventral ramus continues alone to form
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the middle trunk.

• C8 and T1 ventral rami join to form the
inferior trunk.
Each trunk divides into an anterior and
posterior division.

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MYOTOME
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DERMATOME (REVISI UPPER)

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EXAMINATIONS

Motor Sensory Reflex

• Appearance • Pain • Physiological reflex

• Tone • Light touch • Pathological reflex
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• Power • Temperature • Coordination

• Joint position
• Vibration
• 2 point discrimination
• Sensory inattention
• Stereognosis
• Graphanesthesia

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MOTOR: APPEARANCE
• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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MOTOR: TONE
• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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MOTOR: POWER
MRC Scale
Scor Interpretation
e
0 No contraction
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1 Flicker
2 Active movement, gravity eliminated
3 Active movement against gravity
4 Active movement against resistance
5 Normal power

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SENSORY: PAIN, LIGHT TOUCH

AND TEMPERATURE
• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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REFLEX: PHYSIOLOGICAL
REFLEX
• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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REFLEX: PATHOLOGICAL
REFLEX
• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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COORDINATION
• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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TRUNK
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ANATOMY AND PHISIOLOGY

• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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MYOTOME
• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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DERMATOME
• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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EXAMINATIONS

Sensory Reflex

• Pain • Physiological reflex

• Light touch • Pathological reflex
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• Temperature • Coordination
• Joint position
• Vibration
• 2 point discrimination
• Sensory inattention
• Stereognosis
• Graphanesthesia

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SENSORY: PAIN, LIGHT TOUCH

AND TEMPERATURE
• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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REFLEX: PHYSIOLOGICAL
REFLEX
• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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REFLEX: PATHOLOGICAL
REFLEX
• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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LOWER LIMB
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ANATOMY AND PHISIOLOGY

• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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BRACHIAL PLEXUS
• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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MYOTOME AND DERMATOME

• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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EXAMINATIONS

Motor Sensory Reflex

• Appearance • Pain • Physiological reflex

• Tone • Light touch • Pathological reflex
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• Power • Temperature • Coordination

• Joint position
• Vibration
• 2 point discrimination
• Sensory inattention
• Stereognosis
• Graphanesthesia

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MOTOR: APPEARANCE
• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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MOTOR: TONE
• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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MOTOR: POWER
MRC Scale
Scor Interpretation
e
0 No contraction
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1 Flicker
2 Active movement, gravity eliminated
3 Active movement against gravity
4 Active movement against resistance
5 Normal power

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SENSORY: PAIN, LIGHT TOUCH

AND TEMPERATURE
• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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REFLEX: PHYSIOLOGICAL
REFLEX
• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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REFLEX: PATHOLOGICAL
REFLEX
• Deformity or asymmetry
• Wasting
• Hypertophy
• Fasciculation
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• Myokimia

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REFERENCES
1. Snells Clinical Neuroanatomy
2.
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