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NE.RVOUS SYSTEM

277

Table 4-7. Major Peripheral Nerves of the Upper Extremity

Nerve

Spinal RoO[

Innervation

Dorsal scapular

C5

Levaror scapulae, rhomboid major

and minor

Supmscapular

C5 and C6

Supraspinatus, infraspinatus

Lower

C5 and C6

Teres major

subscapular

Axillary

C5 and C6

Teres minor, delraid

Radial

C5, C6, C7,

Triceps, brachioradialis, anconeus,

and C8

extensor carpi radialis longus and

brevis, supinator, extensor carpi

ulnaris, extensor digirorum, extensor

digiti minimi, extensor indicis, extensor pollicis longus and brevis, abducror pollieis brevis

Ulnar

C8 and T I

Flexor digitorum profundus, flexor

carpi uln!lris, palmaris brevis, abducror digiti minimi, flexor digiti minimi

brevis, opponens digiti minimi, palmar and dorsal interossei, third and

fourth lumbricals

Median

C6, C7, C8,

Pronator teres, flexor carpi radialis, pal-

and T l

maris longus, flexor digirorum superficialis and profundus, flexor pallicis

longus, pronaror quadratus, abductor

pollicis brevis, opponens pollieis,

flexor pollicis brevis, first and second

lumbricals

Musculo

C5, C6, and C7

Coracobrachialis, brachialis, biceps

cutaneous

Source: Data from FH Nencr (cd). Arias of Human Anaromy. Summit Ciry, NJ: CIBA

GEIGY Corporation, 1989.

Neurologic Examination

The neurologic examination is initiated on hospital admission or in

the field and is reassessed continuously, hourly or daily, as necessary.

The neurologic examination consists of patient history; mental status

examination; viral sign measurement; vision, motor, sensory, and

coordination testing; and diagnostic resring.

278 AClITE CARE HANDBOOK FOR PHYSICAL Tt-IE.RAI)ISTS

Table 4-8. Major Peripheral Nerves of the Lower Extremiry

Nerve

Spinal Root

Innervation

Femoral

L2, U, and L4

Iliacus

Psoas major

Sartorius

Pecrinous

Rectus femoris

Vastus lateral is, intermedius, and medialis

Articularis genu

Obturator

L2, L3, and L4

Obturator extern LIS

Adductor brevis, longus, and magnus

Gracilis

Sciatic

L4, LS, 5 1 , S2,

Biceps femoris

and S3

Adductor magnus

Semitendinosus

Semimembranosus

Tibial

L4, LS, S], 52,

Gastrocnemius

and S3

Soleus

Flexor digitorum longus

Tibialis posterior

Flexor hallucis longus

Common

L4, LS, S l , and

Peroneus longus and brevis

peroneal

S2

Tibialis amerior

Extensor digitorum longus

Extensor hallucis longus

Extensor hallucis brevis

Extensor digitorum brevis

Source: Dara from FH Nener (cd). Arias of I-Iuman Anawmy. Summir Ciry, Nl: CI8A

GEIGY Corporarion, 1989.

Patietlt History

A detailed history, initially taken by the physician, is often the most

helpful information used to delineate whether a patient presents with

a true neurologic event or another process (usually cardiac or metabolic in nature). The history may be presented by the patient or, more commonly, by a family member or person witnessing the acme or progressive event(s) responsible for hospital admission. One common

NERVOUS SYSTEM

279

Table 4-9. Major Peripheral Nerves of the Trunk

Nerve

Spinal Root

Innervation

Spinal accessory

C3 and C4

Trapezius

Phrenic

C3, C4, and C5

Diaphragm

Long thoracic

C5, C6, and C7

Serratus anterior

Medial pecroral

C6, C7, and C8

Pectoralis minor and

major

Lateral pecroral

C7, C8, and T I

Pectoralis major

Thoracodorsal

C 7 and C8

Latissimus dorsi

Intercostal

Corresponds ro nerve

External intercostals

root level

Internal intercosrals

Levatores costarum longi

and brevis

Iliohypogastric and

L I

Transversus abdominus

ilioinguinal

Internal abdominal

oblique

Inferior gluteal

L4, L5, 51, and 52

Gluteus maximus

Superior gluteal

L4, L5, and 5'1

Gluteus medius and

minlmus

Tensor fascia lame

Source: Data from FH Netter (cd). Arias of Human Anatomy. Summit City, NJ: eIBA

GEIGY Corporation, 1989.

framework for organizing questions regarding each neurologic complaint, sign, or symprom is presented here7,8:

• What is the patient feeling?

•

When did the problem initially occur and has it progressed?

•

What relieves or exacerbates the problem?

• What is the onset, frequency, and duration of signs or symptoms?

In addition to the general medical record review (see Appendix 1-

A), questions relevant to a complete neurologic history include the

following:

• Does the problem involve loss of consciousness?

•

Did a fall precede or follow the problem?

280

AClfrE CARE HANDBOOK FOR PHYSICAl H1FRAPISTS

Vlnuall)tlal

UM of upper

limb

Figure 4-6. Dermatome chart based 0" embryologic segments. (\vith permission from CD Maitland /ed/. Vertebral Manipulation /5th edt. Oxford, UK: Butterworth-H einemallll, 1986;46.)

•

Is there headache, dizziness, or visual disturbance?

•

What are the functional deficits associated with the problem?

•

Is there an alteration of speech?

•

Does the patient demonstrate memory loss or altered cognition?