Читать книгу Neurology - Charles H. Clarke - Страница 191
Root Lesions
ОглавлениеCharacteristics are:
Root pain
Wasting and muscle weakness
Sensory loss, and
Loss/depression of deep tendon reflex(es).
A root lesion is often called radiculopathy when this is part of an inflammatory, vascular or neoplastic process with derivatives such as polyradiculomyelopathy. I prefer the shorter English word root. A cervical or lumbar root lesion usually implies compression, often from a disc. Movements, root values, muscles and nerves are summarised in Table 4.4.
Table 4.4 Movement, root value, muscle & nerve.
| Movement | Root | Muscle | Nerve |
|---|---|---|---|
| Shoulder abduction | C5, (C6) | Deltoid (also supraspinatus) | Axillary |
| Elbow flexion (supinated) | (C5), C6 | Biceps | Musculocutaneous |
| Elbow flexion (mid‐prone) | C5, (C6) | Brachioradialis | Radial |
| Wrist extension | (C6), C7, (C8) | Triceps | Radial |
| Tip of thumb & index finger flexion | C7, C8 | Flexor pollicis and digitorum profundus I, II | Median |
| Tip of ring & Vth finger flexion | C8 | Flexor digitorum profundus IV, V | Ulnar |
| Thumb abduction | T1 | Abductor pollicis brevis | Median |
| Finger abduction | T1 | Dorsal interossei | Ulnar |
| Finger flexion | (C7), C8, (T1) | Long and short flexors | Median and ulnar |
| Hip flexion | L1, L2, (L3) | Iliopsoas | Nerve to iliopsoas |
| Hip adduction | L2, L3, L4 | Adductor magnus | Obturator |
| Knee extension | L3, L4 | Quadriceps femoris | Femoral |
| Ankle dorsiflexion | L4, L5 | Tibialis anterior | Deep peroneal |
| Big toe extension | L5, (S1) | Extensor hallucis longus | Deep peroneal |
| Ankle eversion | L5, S1 | Peroneal muscles | Superficial peroneal |
| Ankle inversion | L4, L5 | Tibialis posterior | Tibial |
| Ankle plantar flexion | S1, S2 | Gastrocnemius, soleus | Posterior tibial |
| Knee flexion | S1, (S2) | Hamstrings | Sciatic |
| Hip extension | S1, (S2) | Gluteus maximus | Inferior gluteal |
Root pain caused by distortion or stretching of meninges surrounding a root is perceived both in the myotome and the dermatome. This is relevant in C7 root compression: pain can be felt deep to the scapula (C7 muscles) while the sensory disturbance runs to the middle finger (C7 dermatome). The triceps jerk is lost. See Chapters 10 and 16.
