Motor function testing of UL / LL myotomes

Question 1

What is the purpose of the technique i.e. what are you measuring and why?

Answer 1

To check for potential weakness that may indicate a loss of nerve innovation or a progressive deficit

Question 2

How do you know whether the measurement is normal?

Answer 2

Ability to replicate force for entire duration

Strong and painless

Question 3

What principles are used in carrying out (application) the technique?

Answer 3

1) Patient comfortable, explain procedure, informed consent
2) Test muscle in mid-range.
3) Use instruction “Don’t let me move you”.
4) Build up to maximal resistance to enable patient to recruit, this
avoids sudden jolt or pain.
5) Hold for 5-10 seconds to check the muscle group can maintain
contraction.
6) complete for entire upper or lower limb & compare to other side

Question 4

What structures/processes are being assessed?

Answer 4

Can be used to check innervation of muscle groups supplied by a particular part of the nervous system e.g. peripheral nerve or nerve root (myotomes).

Question 5

Precautions / contraindications

Answer 5

Injury
Skin condition
Hypertension

Are you feeling well in yourself?
Do you have any injuries I should be aware of?
Do you have any skin conditions?
Do you suffer with hypertension

Question 6

Movements to test myotome: C1 & C2

Answer 6

Neck Flexion

Question 7

Movements to test myotome: C3

Answer 7

Neck lateral flexion

Question 8

Movements to test myotome: C4

Answer 8

Shoulder elevation

Question 8

Movements to test myotome: C5

Answer 8

Shoulder flexion, lateral rotation & Abduction

Question 9

Movements to test myotome: C5-6

Answer 9

Shoulder flexion

Question 10

Movements to test myotome: C6

Answer 10

Supination @ shoulder

Question 11

Movements to test myotome: C6-7

Answer 11

Elbow extension
Wrist flexion & Extension

Question 12

Movements to test myotome: C6-8

Answer 12

Shoulder medial rotation, adduction and extension

Question 13

Movements to test myotome: C7-8

Answer 13

Shoulder pronation
MCP & IP joint flexion and extension

Question 14

Movements to test myotome: C8

Answer 14

Thumb extension

Question 15

Movements to test myotome: T1

Answer 15

Abduction of 3rd finger MCP
Adduction of 2,3,4 finger MCP

Question 16

Movements to test myotome: L1-3

Answer 16

hip flexion and medial rotation

Question 17

Movements to test myotome: L1-4

Answer 17

hip adduction

Question 18

Movements to test myotome: L1 & 5

Answer 18

hip external rotation

Question 19

Movements to test myotome: L3-4

Answer 19

Knee extension

Question 20

Movements to test myotome: L4-5

Answer 20

hip extension & foot inversion

Question 21

Movements to test myotome: L5 - S1

Answer 21

hip abduction & foot eversion

Question 22

Movements to test myotome: L5- S2

Answer 22

Knee flexion

Question 23

Movements to test myotome: S1-2

Answer 23

plantar flexion

Question 24

Movements to test myotome: L5

Answer 24

toe extension

Question 25

Movements to test myotome: S2-3

Answer 25

toe adduction

Question 26

What movements are required to test upper limb myotomes?

Answer 26

Neck flexion: C1-2 Neck lateral flexion: C3 Shoulder elevation: C4 Shoulder flexion: C5, 6 Shoulder supination: C6 Forearm extension: C6, 7 Wrist flexion: C6, 7 Wrist extension: C6, 7 Shoulder medial rotation: C6, 7, 8 Shoulder adduction: C6, 7, 8 Shoulder extension: C6, 7, 8 Shoulder pronation: C7, 8 Finger flexion: C7, 8 Finger extension: C7, 8 Thumb extension: C8 Ulnar deviation: C8 Finger 3 abduction: T1 Finger 2,3,4 adduction: T1

Question 27

What movements are required to test lower limb myotomes?

Answer 27

Hip flexion: L1, 2, 3 Hip Medial rotation: L1, 2, 3 Hip adduction: L1, 2, 3, 4 Hip Lateral rodation: L1 & 5 Knee extension: L3, 4 Hip extension: L4, 5 Foot inversion: L4, 5 Dorsiflexion: L4, 5, S1 Hip Abduction: L5, S1 Foot eversion: L5, S1 Knee Flexion: L5, S1, S2 Toe extension: L5 Plantarflexion: S1, 2 Toe adduction: S2, 3