Download Peripheral Nervous System (PNS) Physical Examination

Myotome (Motor)
Carried by CN XII
Infrahyoid muscles
Ansa cervicalis
Diaphragm
Phrenic
C3
Respiration
C4
Supraspinatus
Suprascapular
Brachialis and
Bicep
Musculocutaneous
Extensor carpi
radialis longus and
brevis
Radial
Extensor carpi ulnaris
Radial
Elbow extension
Triceps
Radial
Finger extension
Extensor digitorum
communis, Extensor
indicis propius, and
Extensor digiti
minimi
Radial
Flexor carpi radialis
Median
2
Elbow flexion,
shoulder flexion,
and forearm
C6
3
C7
Wrist extension
Wrist flexion
5
6
Finger flexion
Finger abduction
T5
T6
Lateral forearm
Thumb, index,
lateral 1/2 middle
finger
5
Triceps tendon
7
Middle finger
Medial forearm
6
Ring finger
Lateral antebrachial
cutaneous
Median anteriorly,
Radial posteriorly
Median anteriorly,
Radial posteriorly
Medial antebrachial
cutaneous
Lateral 1/2 median,
Medial 1/2 ulnar
Little finger
Ulnar
Medial upper arm
Medial brachial
cutaneous
Ulnar
Median
Ulnar
Lumbar flexion
Axillary
Median and Ulnar
Palmar interossei
T9
Supraclavicular
6
Finger adduction
T10
Shoulder
Lateral upper arm
4
Ulnar
Recurrent branch
T8
2
Median
Opponens pollicis
lize
T7
Brachioradialis
tendon
Me
T4
3
Thumb opposition
Rectus abdominus
7
T3
Biceps tendon
*Gray shaded area to left innervated by C5 and C6
2
2 radial lumbricals
T1
T2
Flexor digitorum
superficialis
Flexor digitorum
profundis, and
Lumbricals
Dorsal interossei,
Abductor digiti
quinti, and 2 ulnar
lumbricals
Lesser occipital
3
Flexor carpi ulnaris
C8
1
dic
4
Intercostal muscles
C5
Axillary
Shoulder abduction
Neck, posterior scalp
1
Middle Deltoid
Respiration
Total claw hand ("Klumpke's palsy")
Ulnar claw hand ("Pope's blessing")
Long Thoracic
Erb's Palsy ("Waiter's tip")
Decreased elbow flexion
Paralyzed ("flat") deltoid
Proximal: Cannot oppose thumb ("Ape hand"), Distal: 2nd and 3rd digits clawed ("Median claw")
Wrist drop ("Saturday night palsy")
Serratus anterior ("Winged scapula")
Radial
Median
Brachial
Lower Trunk
Ulnar
Upper Extremity
Musculocutaneous
Axillary
Upper Trunk
1
Peripheral Nerve
Transverse
cervical
Geniohyoid and
Thyrohyoid
Swallowing
C2
Dermatome (Sensory)
Cutaneous Area
Great
auricular
Cervical
C1
Reflex
Peripheral Nerve
8
9
Axilla
Nipple
Xiphoid process
Abdominal
Lateral cutaneous branches
Muscle
Anterior
triangle of
neck
Movement
Posterior ear
and cheek
Nerve Root
ine
.co
m
Lesion
Thoraco-abdominal
Plexus
Intercostal
Extremity
Umbilicus
T11
Groin
Foot inversion
L4
Toe extension
10
Genital branch
Femoral
Obturator
Deep peroneal
Gluteus medius
Superior gluteal
Tibial
Lateral hamstrings
Common peroneal
Defecation
Coccygeus
Top of foot
Superficial peroneal,
Deep peroneal
between 1st-2nd toe
Lateral foot
Sural
14
5
Achilles tendon
Lateral and posterior
plantar foot
S5 branch
Posterior leg and
outer ring around
Superficial anal
anus
and
Middle ring around
Bulbocavernosus
anus
Inner ring around
anus
*This table is not intended to be a complete source for nerve root innervation, but is intended to provide the most pertinent information for clinical evaluation.
**Yellow highlighted areas indicate the most important areas to test on a routine physical exam. Superscript numbers indicate the recommended sequence of exam.
***Exam should begin with myotome, followed by reflex and then dermatome evaluation.
References:
-Bickley, Lynn S., Peter G. Szilagyi, and Barbara Bates. "The Nervous System." Bates' Guide to Physical Examination and History Taking. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009. Print.
-Goldberg, Stephen. Clinical Neuroanatomy: Made Ridiculously Simple. Miami: MedMaster, 1994. Print.
-Gray, Henry, and Warren H. Lewis. Anatomy of the Human Body . 20th ed. Philadelphia: Lea and Febiger, 1918. Print.
-Hoppenfeld, Stanley, and Richard Hutton. Orthopaedic Neurology: A Diagnostic Guide to Neurologic Levels . Philadelphia: Lippincott, 1977. Print.
-Le, Tao, and Vikas Bhushan. "Musculoskeletal." First Aid for the USMLE Step 1. 2010 ed. New York: McGraw-Hill Medical, 2010. 368-72. Print.
-Netter, Frank H., John T. Hansen, and David R. Lambert. Netter's Clinical Anatomy . Carlstadt, NJ: Icon Learning Systems, 2005. Print.
Lateral plantar and
Tibial
Inferior gluteal
Pelvic splanchnic
Gluteus maximus
Common peroneal
superiorly,
Superficial peroneal
inferiorly
Tibialis posterior
tendon
15
Saphenous
Medial plantar
Lateral leg
16
Medial hamstrings
S4
S5
L1-L3 branches
Quadriceps
Cremaster
Iliopsoas
Extensor hallucis
longus, and
Extensor digitorum
longus and brevis
Peroneus longus and
Superficial peroneal
brevis
Gastrocnemius,
Soleus, and Tibialis
15
Foot plantarflexion
posterior
Tibial
Flexor digitorum
longus , and Flexor
Toe flexion
hallucis longus
Hip extension
Medial leg and
medial foot
Medial plantar foot
S2-S3 branches
S3
Patellar tendon
Foot eversion
11
Oblique band on
Genitofemoral
anterior thigh below
inguinal ligament
11
Anterior midthigh
between inguinal
ligament and
Lateral and Anterior
kneecap
femoral cutaneous
12
Oblique band on
anterior thigh above
knee
13
4
Detrusor
S2
Knee flexion
Cremasteric
Tibialis anterior
Foot intrinsics
S1
Hip abduction
13
Urination
Sciatic
Tibial
Common Peroneal
Sacral
Foot dorsiflexion
Toe abduction
and adduction
Decreased knee flexion and other movements below
Decreased foot plantarflexion and inversion
Foot drop
L5
©In
te
Lower Extremity
14
10
Adductor group
12
L3
Hip adduction
Knee extension
8
rna
L2
Hip flexion
Decreased knee extension, hip flexion
Decreased hip adduction
Femoral
Obturator
Lumbar
L1
9
Raise/lower scrotum
T12
Posterior femoral
cutaneous
Coccygeal