T15 - neural integrity tests

• Somatic pain presented though a neuropathic pain mechanism can be a deep dull ache
• Cauda equina special questions:

  • any change in bladder or bowel function
  • saddle anaesthesia? e.g. can feel bottom when wiping
  • sexual dysfunction? e.g. no erection or sensation
  • bilateral symptoms?
  • loss of control of gait?
• General special questions:

  • unexplained weight loss - cancer
  • night pain - cancer
  • any signs of infection
• Babinski test and Clonus test:

  • Upper motor neurone tests
  • can confirm if theres anything wrong with the Central nervous system
• Ankle and Knee jerk reflex:

  • hyperactivity in the response can indicate problem with upper motor neurones - CNS
  • hypoactivity in the response can indicate problem with lower motor neurone - PNS
• • Knee jerk reflex tests the nerve root of L3
  • Ankle jerk reflex tests the nerve root of S1
  • so if there was a radiculopathy affecting the right side, the left side reflexes would be normal, the right side knee reflex would be normal, but the right side ankle reflex would be abnormal
  • if there was hyperactivity in the reflex it would indicate problem with the upper motor neurone
  • if there was hypoactivity in the reflex it would indicate problem with the lower motor neurone
• Myotome root levels:

  • L2 – Hip Flexion
  • L3 – Knee extension
  • L4 – Dorsiflexion
  • L5 – Hallux Extension
  • S1 – Ankle Plantar flexion, Eversion, Hip extension
  • S2 – Knee Flexion

  
• Myotomes and Dermatomes are indicative of lower motor neurones