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Anatomy

Central Nervous System

Question 88 of 180

A 74 year old man presents with a three month history of worsening left shoulder and arm pain. On examination there is weakness of shoulder abduction and reduced sensation over the deltoid. You suspect cervical radiculopathy. What level of the cervical spine is most likely to be affected:

Answer:

The C5 nerve root is most likely affected.

Myotomes and Reflexes

Anatomy / Central Nervous System / Lower Limb / Innervation of Lower Limb / Upper Limb / Innervation of Upper Limb

Last Updated: 13th April 2023

Upper Limb

Table: Myotomes of the Upper Limb

Myotome Most Strongly Associated Movement
C5 Elbow flexion (also shoulder abduction and external rotation)
C6 Wrist extension
C7 Elbow extension (also wrist flexion)
C8 Finger flexion (also thumb extension)
T1 Finger abduction

Lower Limb

Table: Myotomes of the Lower Limb

Myotome Most Strongly Associated Movement
L2 Hip flexion
L3 Knee extension
L4 Ankle dorsiflexion
L5 Great toe extension
S1 Ankle plantarflexion
S2 Knee flexion

Reflexes

Table: Reflexes of the Upper and Lower Limb

Reflex Root Muscle
Biceps C5 – C6 Biceps brachii
Supinator C6 – C7 Brachioradialis
Triceps C7 – C8 Triceps brachii
Knee L3 – L4 Quadriceps
Ankle S1 Gastrocnemius

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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