PT Fundamentals Week 4 - PhysioU Dermatomes, Reflexes, and Myotomes

Questions and Answers

What is the primary focus of a myotomal screen?

To evaluate manual muscle test grades

To perform dynamic movement assessments

To assess muscle strength without grading (correct)

To identify weaknesses in specific muscle groups (correct)

During the myotomal screen, which action corresponds to the L4 innervation?

Knee extension

Dorsiflexion of the ankle (correct)

Great toe extension

Plantar flexion eversion

Which movements are performed for the S1-S2 myotome screen?

Shoulder shrug and side flexion

Wrist extension and elbow flexion

Hip flexion and knee extension

Plantar flexion eversion and resistance against dorsiflexion (correct)

Why is it important to perform myotomal screening bilaterally?

To identify any discrepancies in innervation Signup and view all the answers

In the myotomal screen, the action for C5 specifically tests which muscle function?

Shoulder abduction Signup and view all the answers

What should be avoided when conducting a myotomal screen?

Assigning muscle grades Signup and view all the answers

Which myotomal screen test is associated with the innervation of L5?

Great toe extension Signup and view all the answers

What muscle movement is tested for C3 during the myotomal screening?

Cervical side flexion Signup and view all the answers

What does an exaggerated or sustained reflex indicate?

Upper motor neuron injury Signup and view all the answers

What score represents a completely absent reflex?

Zero Signup and view all the answers

What is the purpose of the Jendrassik maneuver?

To distract the patient and elicit a reflex Signup and view all the answers

Which reflex is assessed by striking the distal biceps tendon?

Biceps reflex Signup and view all the answers

Which score represents an exaggerated reflex response?

Three plus Signup and view all the answers

How should reflexes be scored when performing a reflex test?

Zero to four plus Signup and view all the answers

What should be done if a reflex cannot be elicited due to patient tension?

Use the Jendrassik maneuver Signup and view all the answers

Which reflex involves striking the patellar tendon?

Patellar reflex Signup and view all the answers

In the context of reflex testing, what does a score of one plus indicate?

Slightly depressed reflex Signup and view all the answers

What is the main advantage of using a brush for dermatomal assessment?

More consistent than hand pressure Signup and view all the answers

Which muscle reflex is specifically tested to assess the C6 nerve root?

Biceps Signup and view all the answers

Which condition is indicated by a completely absent reflex?

Lower motor neuron injury Signup and view all the answers

What is a normal grading for reflexes during testing?

Two plus Signup and view all the answers

Which reflex can indicate status of the S1 nerve root?

Achilles tendon reflex Signup and view all the answers

Study Notes

Myotomal Screen for Lower Extremities

Conducted with patients seated in a neutral position.
Focuses on muscle innervation without assigning manual muscle grades.
L1-L2 tests involve hip flexion resistance.
L3 assesses knee extension to evaluate quadriceps.
L4 checks ankle dorsiflexion, resisting against downward pressure.
L5 tests great toe extension in a stable position.
L5-S1 examines plantar flexion resistance while attempting dorsiflexion.
S1-S2 involves plantar flexion eversion, resisting inversion of the foot.

Myotomal Screen for Upper Extremities

Tests are performed bilaterally to identify asymmetries.
C1-C2: cervical flexion with resistance applied to the forehead.
C3: side flexion evaluated on both sides.
C4 assesses shoulder shrug strength.
C5 involves shoulder abduction and resistive elbow flexion.
C6 focuses on wrist extension to isolate nerve innervation.
C7 tests triceps function while maintaining position.
C8 evaluates finger flexion and thumb abduction.
T1 assesses finger abduction by squeezing fingers apart.

Reflex Testing

Integral to neurological assessment, indicating upper/lower motor neuron lesions.
All reflexes should be tested bilaterally, comparing results.
Reflex grading:
- Zero: absent
- One plus: slightly depressed
- Two plus: normal
- Three plus: exaggerated
- Four plus: sustained
Lower motor neuron injuries show depressed or absent reflexes, while upper motor neuron injuries present exaggerated responses.

Techniques to Elicit Reflexes

If patient is tense, instruct them to close their eyes for relaxation.
Use the Jendrassik maneuver for distraction if needed:
- Upper extremity: cup hands, close eyes, and pull apart.
- Lower extremity: cross ankles, close eyes, and pull apart.

Specific Reflex Tests

Patellar reflex: strike tendon between patella and tibial tuberosity, noting bilateral response.
Achilles tendon reflex (S1): stretch tendon slightly while testing in a sitting position.
Biceps reflex: strike distal biceps tendon, looking for movement in the lower arm.
Triceps reflex: support arm, strike tendon proximal to the elbow, and observe response.
Brachioradialis reflex: strike tendon at the musculotendinous junction while forearm is resting.

Dermatomal Assessment

Use a brush for consistent sensation testing in upper and lower extremities.
Patient evaluates sensation accuracy while eyes are closed, indicating equality, difference, or absence of sensation.
Process includes assessing various skin regions through comparatives for comprehensive sensory evaluation.

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Description

This quiz focuses on the myotomal screening process for the lower extremities, highlighting the distinction between myotomal screening and manual muscle testing. Participants will learn about testing innervation and hip flexion resistance for specific lumbar segments. It's essential for understanding nerve function in physical assessments.