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Neurological Screening Examination of C5 to T1 Nerve Roots
This video will present a neurological screening examination for patients presenting with neck pain.
The C5 nerve root is best examined by testing the strength of the deltoid muscle. Ask the patient to abduct the shoulders to 90 degrees. Place your hands over the elbows and ask the patient to maintain shoulder abduction as you press downwards. Compare the strength of shoulder abduction on each side.
The C6 nerve root is best examined by testing the strength of the wrist extensor muscles. Ask the patient to make a fist and then extend their wrist. Stabilize the wrist with one hand and ask the patient to maintain wrist extension as you press downwards. Note the strength of the wrist extension and compare it with the opposite side.
The C7 nerve root is best examined by testing the strength of the wrist flexor muscles. Ask the patient to extend their fingers and then flex their wrist. Stabilize the distal forearm and ask the patient to maintain wrist flexion as you pull to straighten the wrist. Note the strength of wrist flexion and compare it with the opposite side.
The C8 nerve root is best examined by testing the strength of finger flexion. Stabilize the distal forearm and then hook the patient’s fingers with yours. Ask the patient to maintain finger flexion while you pull away. Note the strength of wrist flexion and compare it with the opposite side.
The T1 nerve root is best examined by testing the strength of finger abduction. Ask the patient to spread their fingers. Support the distal forearm and ask the patient to maintain finger abduction while you push inwards with your index finger against their index finger and then repeat using your small finger against their small finger. Note the strength of finger abduction and compare it with the opposite side.
There are key sensory areas in the upper extremities that are indicative of specific nerve roots. The sensory test is performed on both sides simultaneously to assist with the comparison.
With the patient’s eyes closed, touch each of the key sensory areas and ask the patient to report if they can feel the touch and whether they experience the same sensation on both sides.
The key sensory areas are:
For C5, over the lateral aspect of the upper border of the antecubital fossa.
For C6, over the dorsal surface of the thumb at the proximal phalanx.
For C7, over the dorsal surface of the middle finger at the proximal phalanx.
For C8, over the dorsal surface of the little finger at the proximal phalanx.
And for T1, over the medial aspect of the upper border of the antecubital fossa.
Muscle Stretch Reflexes
Muscle stretch reflexes are used to assess the C5, C6, and C7 nerve roots. Each reflex is compared with the opposite side. If the reflex is difficult to obtain, the test can be repeated with the patient clenching their teeth or pressing their knees together.
To assess the C5 nerve root, test the biceps reflex.
To assess the C6 nerve root, test the brachioradialis reflex.
To assess the C7 nerve root, test the triceps reflex.
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