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Dr. Kaan Yücel http://yeditepeanatomy1.org Yeditepe Anatomy NEUROLOGICAL EXAMINATION MOTOR & SENSORY FUNCTION AN ANATOMICAL GUIDE SHOULDER To test the deltoid (or the function of the axillary nerve that supplies it), the arm is abducted, starting from approximately 15°, against resistance. If acting normally, the deltoid can easily be seen and palpated. The influence of gravity is avoided when the person is supine. To test the supraspinatus, abduction of the arm is attempted from the fully adducted position against resistance, while the muscle is palpated superior to the spine of the scapula. The supraspinatus and the middle deltoid muscles are tested together. To test the infraspinatus, the person flexes the elbow and adducts the arm. The arm is then laterally rotated against resistance. If acting normally, the muscle can be palpated inferior to the scapular spine. To test the function of the suprascapular nerve, which supplies the supraspinatus and infraspinatus, both muscles must be tested as described. The two lateral rotator muscles; the infraspinatus and teres minör are tested together. To test for degenerative tendonitis of the rotator cuff, the person is asked to lower the fully abducted limb slowly and smoothly. From approximately 90° abduction, the limb will suddenly drop to the side in an uncontrolled manner if the rotator cuff (especially the supraspinatus part) is diseased and/or torn. ARM To test the biceps brachii, the elbow joint is flexed against resistance when the forearm is supinated. If acting normally, the muscle forms a prominent bulge on the anterior aspect of the arm that is easily palpated. To test the brachialis, the forearm is semipronated and flexed against resistance. If acting normally, the contracted muscle can be seen and palpated. To test the triceps (or to determine the level of a radial nerve lesion), the arm is abducted 90° and then the flexed forearm is extended against resistance provided by the examiner. If acting normally, the triceps can be seen and palpated. Its strength should be comparable with the contralateral muscle, given consideration for lateral dominance (right or left handedness). ANTERIOR COMPARTMENT OF THE FOREARM To test the flexor carpi ulnaris, the person puts the posterior aspect of the forearm and hand on a flat table and is then asked to flex the wrist against resistance while the examiner palpates the muscle and its tendon. To test the palmaris longus, the wrist is flexed and the pads of the little finger and thumb are tightly pinched together. If present and acting normally, the tendon can be easily seen and palpated. To test the flexor carpi radialis, the person is asked to flex the wrist against resistance. If acting normally, its tendon can be easily seen and palpated. To test the pronator teres, the person's forearm is flexed at the elbow and pronated from the supine position against resistance provided by the examiner. If acting normally, the muscle is prominent and can be palpated at the medial margin of the cubital fossa. To test the flexor digitorum superficialis, one finger is flexed at the proximal interphalangeal joint against resistance and the other three fingers are held in an extended position to inactivate the flexor digitorum profundus. To test the flexor digitorum profundus, the proximal interphalangeal joint is held in the extended position while the person attempts to flex the distal interphalangeal joint. The integrity of the median nerve in the proximal forearm can be tested by performing this test using the index finger, and that of the ulnar nerve can be assessed by using the little finger. To test the flexor pollicis longus, the proximal phalanx of the thumb is held and the distal phalanx is flexed against resistance. POSTERIOR COMPARTMENT OF THE FOREARM & HAND http://www.youtube.com/yeditepeanatomy 1 Dr. Kaan Yücel http://yeditepeanatomy1.org Yeditepe Anatomy To test the brachioradialis, the elbow joint is flexed against resistance with the forearm in the midprone position. If the brachioradialis is acting normally, the muscle can be seen and palpated. To test the extensor carpi radialis longus, the wrist is extended and abducted with the forearm pronated. If acting normally, the muscle can be palpated inferoposterior to the lateral side of the elbow. Its tendon can be palpated proximal to the wrist. To test the extensor digitorum, the forearm is pronated and the fingers are extended. The person attempts to keep the digits extended at the metacarpophalangeal joints as the examiner exerts pressure on the proximal phalanges by attempting to flex them. If acting normally, the extensor digitorum can be palpated in the forearm, and its tendons can be seen and palpated on the dorsum of the hand. To test the extensor carpi ulnaris, the forearm is pronated and the fingers are extended. The extended wrist is then adducted against resistance. If acting normally, the muscle can be seen and palpated in the proximal part of the forearm and its tendon can be felt proximal to the head of the ulna. To test the extensor digiti minimi, the little finger is extended against resistance while holding digits 2-4 flexed at the metacarpophalangeal joints. To test the abductor pollicis longus, the thumb is abducted against resistance at the metacarpophalangeal joint. If acting normally, the tendon of the muscle can be seen and palpated at the lateral side of the anatomical snuff box and on the lateral side of the adjacent extensor pollicis brevis tendon. To test the extensor pollicis brevis, the thumb is extended against resistance at the metacarpophalangeal joint. If the extensor pollicis brevis is acting normally, the tendon of the muscle can be seen and palpated at the lateral side of the anatomical snuff box and on the medial side of the adjacent abductor pollicis longus tendon. To test the extensor pollicis longus, the thumb is extended against resistance at the interphalangeal joint. If the extensor pollicis longus is acting normally, the tendon of the muscle can be seen and palpated on the medial side of the anatomical snuff box. To test the abductor pollicis brevis, abduct the thumb against resistance. If acting normally, the muscle can be seen and palpated. To test the flexor pollicis brevis, flex the thumb against resistance. If acting normally, the muscle can be seen and palpated; however, keep in mind that the flexor pollicis longus also flexes the thumb. To test the lumbrical muscles, with the palm facing superiorly the patient is asked to flex the metacarpophalangeal (MP) joints while keeping the interphalangeal joints extended. The examiner uses one finger to apply resistance along the palmar surface of the proximal phalanx of digits 2-5 individually. Resistance may also be applied separately on the dorsal surface of the middle and distal phalanges of digits 2-5 to test extension of the interphalangeal joints, also while flexion of the MP joints is maintained. To test the dorsal interossei, the examiner holds adjacent extended and adducted fingers between thumb and middle finger, providing resistance as the individual attempts to abduct the fingers (the person is asked to “spread the fingers apart”). To test the palmar interossei, a sheet of paper is placed between adjacent fingers. The individual is asked to “keep the fingers together” to prevent the paper from being pulled away by the examiner. SUPERFICIAL MUSCLES OF THE BACK To test the trapezius (or the function of the spinal accessory nerve [CN XI] that supplies it), the shoulder is shruggedx against resistance (the person attempts to raise the shoulders as the examiner presses down on them). If the muscle is acting normally, the superior border of the muscle can be easily seen and palpated. To test the latissimus dorsi (or the function of the thoracodorsal nerve that supplies it), the arm is abducted 90° and then adducted against resistance provided by the examiner. If the muscle is normal, the anterior border of the muscle can be seen and easily palpated in the posterior axillary fold. To test the rhomboids (or the function of the dorsal scapular nerve that supplies them), the individual places his or her hands posteriorly on the hips and pushes the elbows posteriorly against resistance provided by the examiner. If the rhomboids are acting normally, they can be palpated along the medial borders of the scapulae; because they lie deep to the trapezius, they are unlikely to be visible during testing. PECTORAL REGION & MAMMARY GLANDS To test the clavicular head of pectoralis major, the arm is abducted 90°; the individual then moves the arm anteriorly against resistance. If acting normally, the clavicular head can be seen and palpated. http://www.youtube.com/yeditepeanatomy 2 Dr. Kaan Yücel http://yeditepeanatomy1.org Yeditepe Anatomy To test the sternocostal head of the pectoralis major, the arm is abducted 60° and then adducted against resistance. If acting normally, the sternocostal head can be seen and palpated. To test the serratus anterior (or the function of the long thoracic nerve that supplies it), the hand of the outstretched limb is pushed against a wall. If the muscle is acting normally, several digitations of the muscle can be seen and palpated. THIGH & POPLITEAL FOSSA Testing the quadriceps is performed with the person in the supine position with the knee partly flexed. The person extends the knee against resistance. During the test, contraction of the rectus femoris should be observable and palpable if the muscle is acting normally, indicating that its nerve supply is intact. To test the hamstrings, the person flexes his leg against resistance. Normally, these muscles—especially their tendons on each side of the popliteal fossa—should be prominent as they bend the knee. LEG To test the the tibialis anterior, the person is asked to stand on the heels or dorsiflex the foot against resistance; if normal, its tendon can be seen and palpated. To test the extensor hallucis longus, the great toe is dorsiflexed against resistance; if acting normally, its entire tendon can be seen and palpated. To test the extensor digitorum longus, the lateral four toes are dorsiflexed against resistance; if acting normally, the tendons can be seen and palpated. The extensor digitorum longus extends the toes and dorsiflexes the foot at the ankle joint. To test the fibularis longus and brevis, the foot is everted strongly against resistance; if acting normally, the muscle tendons can be seen and palpated inferior to the lateral malleolus. To test the triceps surae, the foot is plantarflexed against resistance (e.g., by “standing on the toes,” in which case body weight [gravity] provides resistance). If normal, the calcaneal tendon and triceps surae can be seen and palpated. To test the flexor hallucis longus, the distal phalanx of the great toe is flexed against resistance; if normal, the tendon can be seen and palpated on the plantar aspect of the great toe as it crosses the joints of the toe. To test the flexor digitorum longus, the distal phalanges of the lateral four toes are flexed against resistance; if they are acting normally, the tendons of the toes can be seen and palpated. To test the tibilalis posterior, the foot is inverted against resistance with the foot in slight plantarflexion; if normal, the tendon can be seen and palpated posterior to the medial malleolus. http://www.youtube.com/yeditepeanatomy 3 Dr. Kaan Yücel http://yeditepeanatomy1.org Yeditepe Anatomy RegIons & MUSCLES Anterior arm: Coracobrachialis Function flexion- adduction arm Brachialis main flexor of forearm Biceps brachii flexor of the forearm @ elbow joint supinator of forearm when elbow flexed Posterior arm: Triceps brachii Function forearm extension Anterior forearm sprfcl: Flexor carpi ulnaris Palmaris longus Flexor carpi radialis Pronator teres Function flexor and adductor of wrist flexor of wrist flexor,abductor of wrist rotates radius over ulna Anterior forearm intermediate: Flexor digitorum superficialis Function flexes metacarpophalangeal joint- proximal interphalangeal joint , flexes wrist Anterior forearm deep: Flexor digitorum profundus Flexor pollicis longus Pronator quadratus Function flexes the distal phalanges flexes thumb prime mover for pronation Posterior forearm sprfcl: Brachioradialis Extensor carpi radialis longus Extensor carpi radialis brevis Extensor digitorum Extensor digiti minimi Extensor carpi ulnaris Anconeus Function Brachioradialis flexion of forearm; maximal when forearm in midpronated position, others extending the hand (…radialis abducting the hand, …ulnaris adducting the hand) Posterior forearm deep: Supinator Abductor pollicis longus Extensor pollicis brevis Extensor pollicis longus Extensor indicis Function Supinator: supination of forearm, abduction of thumb, extension of proximal (EPB) and distal (EPL) phalanges Hand: Palmaris brevis Adductor pollicis Thenar Hypothenar Function adductor of the thumb opposition,flexion,abduction Lumbricals Interossei Function flex metacarpophalangeal joints & extendi interphalangeal joints palmar:adduction of fingers, dorsal: abduction @ metacarpophalangeal joints Latissimus dors adductor of the humerus; downward rotation of the scapula Levator scapulae Rhomboids Function elevates scapula, or fix it retract & rotate scapula; assist the serratus anterior in holding the scapula against the thoracic wall Deltoid Subscapularis Supraspinatus Function abduction of the arm beyond the initial 15° Medially rotates arm initiates & assists deltoid in abduction of arm İnfraspinatus Teres minor Teres major Function laterally rotates arm adducts and medially rotates arm Back: Serratus posterior superior Serratus posterior inferior Function elevate and depress the ribs Shoulder: Trapezius Function rotates the lateral aspect of the scapula upward Pectoral region: Pectoralis major Pectoralis minor Subclavius Serratus anterior Function adduction & medial rotation of the arm pull the tip of the shoulder inferiorly rotates the scapula, elevating its glenoid cavity so the arm can be raised above the shoulder http://www.youtube.com/yeditepeanatomy 4 Dr. Kaan Yücel http://yeditepeanatomy1.org Yeditepe Anatomy RegIons & MUSCLES Gluteal region superficial: Gluteus maximus Gluteus medius & minimus Tensor fasciae latae Function extends the flexed thigh Abduct and medially rotate thigh Gluteal region deep: Piriformis Obturator internus Gemellus superior Gemellus inferior Quadratus femoris Function abduct flexed thigh (excp q.f.) laterally rotate extended thigh& steady femoral head in acetabulum Anterior thigh: Ilıopsoas Quadriceps femoris Sartorius Function chief flexor of the thigh, hip flexor Extends leg at knee joint Flexes, abducts, and laterally rotates thigh at hip joint; flexes leg at knee joint Medial thigh: Adductor longus Adductor brevis Adductor magnus Gracilis Function Adducts thigh Adducts thigh; flexes leg; helps rotate leg medially Pectineus Obturator externus Function Adducts and flexes thigh; assists with medial rotation of thigh Laterally rotates thigh; steadies head of femur in acetabulum Posterior thigh: Semitendinosus Semimembranosus Function Extend thigh; flex leg & rotate it medially when knee is flexed; when thigh and leg are flexed, these muscles can extend trunk Biceps femoris Function Flexes leg and rotates it laterally when knee is flexed; extends thigh (e.g., accelerating mass during first step of gait) Anterior leg: Tibialis anterior Extensor hallucis longus Function Dorsiflexes ankle and inverts foot Extends great toe and dorsiflexes ankle Extensor digitorum longus Fibularis tertius Function Extends lateral four digits and dorsiflexes ankle Dorsiflexes ankle and aids in eversion of foot Lateral leg: Fibularis longus Fibularis brevis Function Everts foot and weakly plantarflexes ankle Posterior leg superficial: Gastrocnemius Function Plantarflexes ankle when knee is extended; raises heel during walking; flexes leg at knee joint Soleus Plantaris Function Plantarflexes ankle independent of position of knee; steadies leg on foot Weakly assists gastrocnemius in plantarflexing ankle Posterior leg deep: Popliteus Flexor hallucis longus Function Weakly flexes knee Flexes great toe at all joints; weakly plantarflexes ankle; supports medial longitudinal arch of foot Flexor digitorum longus Tibialis posterior Function Flexes lateral four digits; plantarflexes ankle; supports longitudinal arches of foot Plantarflexes ankle; inverts foot Foot (Dorsum): Extensor digitorum brevis Extensor hallucis brevis Function Extends metatarsophalangeal joint of the great toe, and the three middle toes Foot (Sole,1st layer): Abductor hallucis Flexor digitorum brevis Abductor digiti minimi Function Abducts and flexes 1st digit Flexes lateral four digits Abducts and flexes little toe Foot (Sole,2nd layer): Quadratus plantae Function Assists flexor digitorum longus in flexing lateral four digits Lumbricals Flex proximal phalanges, extend middle and distal phalanges of lateral four digits Foot (Sole,3rd layer): Flexor hallucis brevis Adductor hallucis Function Flexes proximal phalanx of 1st digit adduct 1st digit; assists in transverse arch of foot by metatarsals medially Flexor digit minimi brevis Function Flexes proximal phalanx of 5th digit Foot (Sole,4th layer): Plantar interossei (three muscles) Dorsal interossei (four muscles) Function Adduct digits (2-4) and flex metatarsophalangeal joints Abduct digits (2-4) and flex metatarsophalangeal joints http://www.youtube.com/yeditepeanatomy 5 Dr. Kaan Yücel http://yeditepeanatomy1.org Yeditepe Anatomy REGIONS & Nerves (Motor INNERVATION ONLY) Anterior arm: Musculocutaneous nerve Posterior arm: Radial nerve Anterior forearm: Median nerve & ulnar nerve (flexor carpi ulnaris, medial half of flexor digitorum profundus) Posterior forearm: Radial nerve Hand: All of the intrinsic muscles of the hand are innervated by the deep branch of the ulnar nerve except for the three thenar and two lateral lumbrical muscles, which are innervated by the median nerve. Shoulder: Axillary nerve, Suprascapular nerve, Sup. & Inf. subscapular nerves, Accessory nerve [XI], Thoracodorsal nerve, Dorsal scapular nerve Back: Accessory nerve [XI], Thoracodorsal nerve, Dorsal scapular nerve, Intercostal nerves, the superior by the first four intercostals and the inferior by the last four Pectoral region: Lateral and Medial pectoral nerves, Nerve to subclavius, Long thoracic nerve Gluteal region: Superior gluteal nerve, Inferior gluteal nerve, Nerve to the quadratus femoris, Nerve to the obturator internus Anterior thigh: Femoral nerve Medial thigh: Obturator nerve Posterior thigh: Sciatic nerve Anterior leg: Deep peroneal nerve Lateral leg: Superfical peroneal nerve Posterior leg: Tibial nerve Foot: All intrinsic muscles of the foot are innervated by the medial and lateral plantar branches of the tibial nerve except extensor digitorum brevis, which is innervated by the deep fibular nerve. http://www.youtube.com/yeditepeanatomy 6 Dr. Kaan Yücel http://yeditepeanatomy1.org Yeditepe Anatomy REGIONS & sensory INNERVATION Shoulder: supraclavicular nerves (medial,intermediate,lateral) the skin as far as the middle line, the skin over the pectoralis major and deltoideus, the skin of the upper and posterior parts of the shoulder, inferior part of the deltoid muscle (axillary nerve) Anterior arm: inferior lateral cutaneous nerve of the arm (radial nerve) lateral and anterior aspects of the lower part of the arm medial cutaneous nerve of arm back of the lower third of the arm, extending as far as the elbow superior lateral cutaneous nerve of arm (axillary nerve) the skin over the lower two-thirds of the posterior part of the deltoid muscle, as well as that covering the long head of the triceps brachii Anterior forearm: medial cutaneous nerve of forearm medial surface of the forearm down to the wrist lateral cutaneous nerve of forearm (continuation of musculocutaneous nerve) lateral half of the anterior aspect of the forearm Posterior arm & forearm: radial nerve posterior aspect of the arm and forearm (posterior cutaneous nerve of forearm), lower lateral surface of the arm, medial cutaneous nerve of arm medial side of the distal third of the arm Hand: superficial branch of the radial nerve dorsolateral aspect of the palm and the dorsal aspects of the lateral three and one-half digits distally to approximately the terminal interphalangeal joints ulnar nerve medial side of the palm, medial half of the dorsum of the hand, the 5th finger, and the medial half of the 4th finger, anterior surfaces of the medial one and a half digits median nerve thumb,index,middle fingers,lateral side of the ring [distal parts on the dorsum of the hand], palmar surface of the lateral three and one-half digits and over the lateral side of the palm and middle of the wrist Gluteal region: Upper lateral quadrant of the gluteal region is supplied by the lateral branches of the iliohypogastric (L1) and 12th thoracic nerves (anterior rami). Superior clunial nerves L1-L3 posterior rami Skin overlying superior and central parts of buttock Medial clunial nerves S1-S3 posterior rami Skin of medial buttock and intergluteal cleft Inferior clunial nerves Posterior cutaneous nerve of thigh (S2-S3) Skin of inferior buttock (overlying gluteal fold Thigh: obturator nerve superior medial thigh, genitofemoral nerve middle anterior thigh, posterior cutaneous nerve of the thigh posterior aspect of the thigh, intermediate cutaneous nerve of the thigh (femoral nerve) variable area on the medial aspect of the thigh, the medial cutaneous nerve of the thigh (femoral nerve) medial aspect of the thigh Leg: saphenous nerve (femoral nerve) medial aspect of leg, posterior cutaneous nerve of the thigh upper part of the leg superficial fibular nerve anterolateral leg, sural nerve posterolateral leg Foot: Medially saphenous nerve, which extends distally to the head of 1st metatarsal. Superiorly (dorsum of foot) superficial (primarily) and deep fibular nerves. Inferiorly (sole of foot) medial and lateral plantar nerves; the common border of their distribution extends along the 4th metacarpal and toe or digit. (This is similar to the pattern of innervation of the palm of the hand.) Laterally sural nerve, including part of the heel. Posteriorly (heel) medial and lateral calcaneal branches of the tibial and sural nerves, respectively. http://www.youtube.com/yeditepeanatomy 7 Dr. Kaan Yücel http://yeditepeanatomy1.org Yeditepe Anatomy REGIONS & DERMATOMES A dermatome is an area of skin that is mainly supplied by a single spinal nerve. The areas of skin supplied by the individual spinal nerves, including those contributing to the plexuses, are called dermatomes. There are eight cervical nerves (C1 being an exception with no dermatome), twelve thoracic nerves, five lumbar nerves and five sacral nerves. Each of these nerves relays sensation (including pain) from a particular region of skin to the brain. The nerve fibers from a particular segment of the spinal cord, although they exit from the cord in a spinal nerve of the same segment, pass to the skin in two or more different cutaneous nerves. The dermatomal (segmental) pattern of skin innervation is retained throughout life but is distorted by limb lengthening and the torsion of the limb that occurs during development. The dermatomes for the upper cervical segments C3 to 6 are located along the lateral margin of the upper limb; the C7 dermatome is situated on the middle finger; and the dermatomes for C8, T1, and T2 are along the medial margin of the limb. The skin over the point of the shoulder and halfway down the lateral surface of the deltoid muscle is supplied by the supraclavicular nerves (C3 and 4). Pain may be referred to this region as a result of inflammatory lesions involving the diaphragmatic pleura or peritoneum. The afferent stimuli reach the spinal cord via the phrenic nerves (C3, 4, and 5). Pleurisy, peritonitis, subphrenic abscess, or gallbladder disease may therefore be responsible for shoulder pain. http://www.youtube.com/yeditepeanatomy 8 Dr. Kaan Yücel http://yeditepeanatomy1.org Yeditepe Anatomy Sensory Innervation of the Lower Limb Iliohypogastric (L1; occasionally T12) superolateral quadrant of buttock Ilioinguinal (L1; occasionally T12) Skin over medial femoral triangle Genitofemoral Lumbar plexus (L1-L2) Femoral branch supplies skin over lateral part of femoral triangle; genital branch supplies anterior scrotum or labia majora Lateral cutaneous nerve of thigh Lumbar plexus (L2-L3) Skin on anterior and lateral aspects of thigh Anterior cutaneous branches Lumbar plexus via femoral nerve (L2-L4) Skin of anterior and medial aspects of thigh Cutaneous branch of obturator nerve Lumbar plexus via obturator nerve, anterior branch (L2L4) Skin of middle part of medial thigh Posterior cutaneous nerve of thigh Sacral plexus (S1-S3) Skin of posterior thigh and popliteal fossa Saphenous nerve Lumbar plexus via femoral nerve (L3-L4) Skin on medial side of leg and foot Superficial fibular nerve Common fibular nerve (L4-S1) Skin of anterolateral leg and dorsum of foot, excluding web between great and 2nd toes Deep fibular nerve Common fibular nerve (L5) Skin of web between great and 2nd toes Sural nerve Tibial and common fibular nerves (S1-S2) Skin of posterolateral leg and lateral margin of foot Medial plantar nerve Tibial nerve (L4-L5) Skin of medial side of sole, and plantar aspect, sides, and nail beds of medial 3½ toes Lateral plantar nerve Tibial nerve (S1-S2) Skin of lateral sole, and plantar aspect, sides, and nail beds of lateral 1½ toes Calcaneal nerves Tibial and sural nerves (S1-S2) Skin of heel http://www.youtube.com/yeditepeanatomy 9 Dr. Kaan Yücel http://yeditepeanatomy1.org Yeditepe Anatomy reflexes Tendon Reflexes and the Segmental Innervation of Muscles of the Upper Limb The skeletal muscle receives a segmental innervation. Most muscles are innervated by several spinal nerves and therefore by several segments of the spinal cord. A physician should know the segmental innervation of the following muscles because it is possible to test them by eliciting simple muscle reflexes in the patient: Biceps brachii tendon reflex: C5 and 6 (flexion of the elbow joint by tapping the biceps tendon) Triceps tendon reflex: C6, 7, and 8 (extension of the elbow joint by tapping the triceps tendon) Brachioradialis tendon reflex: C5, 6, and 7 (supination of the radioulnar joints by tapping the insertion of the brachioradialis tendon) A tap on the tendon of biceps brachii at the elbow is used to test predominantly spinal cord segment C6. A tap on the tendon of triceps brachii tests predominantly spinal cord segment C7. Patellar Reflex The quadriceps femoris is innervated by the femoral nerve. A tap with a tendon hammer on the patellar ligament therefore tests reflex activity mainly at spinal cord levels L3 and L4. Calcaneal Tendon Reflex The ankle jerk reflex, or triceps surae reflex, is a calcaneal tendon reflex. It is a myotatic reflex elicited while the person's legs are dangling over the side of the examining table. The calcaneal tendon is struck briskly with a reflex hammer just proximal to the calcaneus. The normal result is plantarflexion of the ankle joint. The calcaneal tendon reflex tests the S1 and S2 nerve roots. If the S1 nerve root is injured or compressed, the ankle reflex is virtually absent. http://www.youtube.com/yeditepeanatomy 10 Dr. Kaan Yücel http://yeditepeanatomy1.org Yeditepe Anatomy NEUROLOGICAL EXAM Online resources NeuroLogic Examination Videos and Descriptions...an Anatomical Approach http://library.med.utah.edu/neurologicexam/html/home_exam.html The Precise Neurological Exam http://cloud.med.nyu.edu/modules/pub/neurosurgery/ Neuroexam http://www.neuroexam.com/neuroexam/ Neurologic Examination http://medinfo.ufl.edu/year1/bcs/clist/neuro.html The Neurological Examination http://www.aan.com/familypractice/pdf/FINAL%20THE%20NEUROLOGIC%20EXAMINATION.pdf What is a Neurological Exam? http://peripheralneuropathycenter.uchicago.edu/learnaboutpn/evaluation/neuroexam/index.shtml The Neurological Examination http://meded.ucsd.edu/clinicalmed/neuro2.htm Neurologic Exam http://www.uic.edu/classes/pmpr/pmpr652/Final/Winkler/NEUROEXM.html http://www.youtube.com/yeditepeanatomy 11