Myotome assessment is an essential part of neurological examination when suspecting radiculopathy, as changes in muscle strength within a specific myotome may help you identify the pathological disc level. Al Nezari et al. (2013) performed a systematic review and meta-analysis of 14 different studies investigating sensory, motor, and reflex testing for lumbar disc herniations. The results showed that testing for paresis in myotomes had 22-40% sensitivity and 62-79 percent specificity which corresponds to a sensitivity of 31% and a specificity of 76%in the identification of the pathological disk level. The pooled positive likelihood ratios for all neurological examination components range between 1.02 and 1.26. So positive or negative findings don’t raise the post-test probability much at all which is why we attribute this assessment a rather weak clinical value.
Despite these findings, it’s still the best tool we have in physical assessment. Myotome testing of the lower extremity is done with the patient in supine lying position. As with sensory assessment, you should compare the affected and unaffected side.
L2 = hip flexion
L3 : Hip Extension
L4: Tibialis Anterior / ankle dorsiflexion
L5: Extensor Hallucis Longus / Great Toe Extension
S1: Calf Muscles / Ask the Patient to perform a calf raise (several times)
Even though nerve root pathology is very rare on sacral level S2, weakness in knee flexion would indicate such compromise.
21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE
Other parts of the neurological examination of the upper limb are:
What customers have to say about the Assessment E-Book
The Assessment E-Book This book helped me in my studying for my exam and in assessing my first patients. Awesome! Also for beginners!
The Assessment E-Book It’s an amazing Compilation! Congrats to all the work you have put in there. You’ll propably find all the test’s you’ve been looking for with propper explaination and source to doublecheck for you self. definetly a must have for every student, but it will also help an experienced practioner. Im looking forward to the lifelong updates on the topics.
Great work, guys
The Assessment E-Book A must-have for all physiotherapists, osteopaths and manual therapists. The authors conducted an extensive research on assessment tests in manual therapy. I find it very easy to read. The more I read the more I learn. Thank you!
The Assessment E-Book This book is great! It is very structured and detailed. It works extremely well on my Macbook and iPad.
The Assessment E-Book The best way to spend 80euros. Totally worth it. The amount of work you put behind this must have been absolutely huge. Every physical or physiotherapist should own it.
Congrats guys you’ve done an incredible job.
I’ve learnd a lot of new things and my approach to therapy in general have totally changed.
In one word: amazing. Keep going guys ! Best wishes from france.
This content is for members
Create your free account to gain access to this exclusive content and more!
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
The technical storage or access that is used exclusively for statistical purposes.The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.