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AIDS TO THE
EXAMINATION
, ,
OF THE PERIPHERAL
NERVOUS SYSTEM
Iw. B. SAUNDERS I
On hc:half of the l,U.JrJ,nlOn of Brain
FOURTH EDITION
AIDS TO THE
EXAMINATION
OF THE PERIPHERAL
NERVOUS SYSTEM
W.B. SAUNDERS
EDINBURGH LONDON NEW YORK PHILADELPH IA ST LOUIS SYDNEY TORONTO 20 0 0
W. B. SAUNDERS
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PREFACE
In 1940 Dr George Riddoch was Consultant Neurologist to the Army. He realised the
necessity of providing centres to deal with peripheral nerve injuries during the war. In
collaboration with Professor J. R. Learrnonth, Professor of Surgery at the University of
Edinburgh, peripheral nerve injury centres were established at Gogarburn near
Edinburgh and at Killearn near Glasgow. Professor Learmonth wished to have an
illustrated guide on peripheral nerve injuries for the use of surgeons working in general
hospitals. In collaboration with Dr Ritchie Russell, a few photographs demonstrating the
testing of individual muscles were taken in 1941. Dr Ritchie Russell returned to Oxford in
1942 and was replaced by Dr M. J. McArdle as Neurologist to Scottish Command. The
photographs were completed by Dr McArdle at Gogarburn with the help of the
Department of Medical Illustration at the University of Edinburgh. About twenty copies in
loose-leaf form were circulated to surgeons in Scotland.
In 1943 Professor Learmonth and Dr Riddoch added the diagrams illustrating the
innervation of muscles by various peripheral nerves modified from Pitres and Testut,
(Les Neufs en Schemas, Doin, Paris, 1925) and also the diagrams of cutaneous sensory
distributions and dermatomes. This work was published by the Medical Research
Council in 1943 as Aids to the Investigation of Peripheral Nerve Injuries (War Memorandum
No.7). It became a standard work and over the next thirty years many thousands of
copies were printed.
It was thoroughly revised between 1972 and 1975 with new photographs and many new
diagrams and was republished under the title Aids to the Examination of the Peripheral
Nervous System (Memorandum No. 45), reflecting the wide use made of this booklet by
students and practitioners and its more extensive use in clinical neurology, which was
rather different from the war time emphasis on nerve injuries.
In 1984 the Medical Research Council transferred responsibility for this publication to
the Guarantors of Brain for whom a new edition was prepared. Modifications were made to
some of the diagrams and a new diagram of the lumbosacral plexus was included.
Most of the photographs for the 1943, 1975 and 1986 editions show Dr McArdle, who
died in 1989, as the examining physician. A new set of colour photographs has been
prepared for this edition, the diagrams of the brachial plexus and lumbosacral plexus have
been retained, but all the other diagrams have been redrawn.
ACKNOWLEDGEMENIS
Patricia Archer PhD for the drawings of the brachial plexus;amld JIlIkMm;
Ralph Hutchings for the photography
Paul Richardson for the artwork and diagrams
Michael Hutchinson MB BDS for advice on the neum-anatomy
Sarah Keer-Keer (Harcourt Publishers) for her help and
CONTENTS
Introduction 1
Spinal accessory nerve 3
Brachial plexus 4
Musculocutaneous nerve 12
Axillary nerve 14
Radial nerve 16
Median nerve 24
Ulnar nerve 30
Lumbosacral plexus 37
Nerves of the lower limb 38
Dermatomes 56
Nerves and root supply of muscles 60
Commonly tested movements 62
INTRODUCTION
This at las is intended as a guide to t he exami natio n of pat ients with lesion s of periph eral
nerves and nerve roots.
These examinations sho uld, if pos sible , be co nduc te d in a qu iet room where pat ien t
and examiner will be free fro m distracti on . For both moto r and sen so ry testing it is
important th at the patient sho uld first be warm. The nature and object of th e tests sh ould
be explained to th e patient so t ha t his in teres t and co-op erat ion are sec ure d. If e it her
shows signs of fatig ue, t he session sho uld be discont in ued a nd resum ed late r.
Motor testing
Amuscle may act as a prime mover, as a fixator, as an antagonist, o r as a synergist. Thus, flexor
carpi ulna ris acts as a prime mover when it flexes and ad du c ts t he wrist; as a fixator when it
immobilises the pisiform bone du ring contractio n of th e adductor d igit i mini mi; as an
antagonist when it resist s extens ion of th e wrist; and as a synergist when th e digits, but not
the wrists, are extended.
As far as possible the acti o n o f ea ch muscle sho uld be obse rved se pa rate ly and a not e
made of th ose in whic h power has be en re tai ne d as well as of th ose th a t are wea k o r
paralysed. It is usual to examine th e power of a muscle in relatio n to th e movement of a
single joint. It has lon g been customary to use a 0 to 5 sca le for recordi ng muscle powe r,
but it is gene rally recogn ised th at su bd ivisio n of grade 4 may be help ful.
o No co ntraction
1 Flicker or t race of co nt raction
2 Active movement, with gravity eliminate d
3 Active moveme nt against gravity
4 Active movement against gravity and resistan ce
5 Normal powe r
Grades 4-, 4 and 4 +, may be used to ind icat e movem ent aga ins t slight. mod erat e an d
strong resistan ce respec t ively.
The models employed in this work were not c hose n becau se th ey showe d unusual
muscular developm en t; th e ease wit h whic h the co nt rac tio n of muscles is ide nt ified varies
with the build of the pat ien t, and it is essent ial th at th e examiner sho uld both look for an d
endeavour to feel the contraction of an accessible mu scle and/or th e movement of its
tendon. In most of the illustrations the opti mu m point for palpation has been marked.
Muscles have been arranged in the order of th e origin of th eir mot or supply from nerve
trunks, whic h is co nvenie nt in many exam inations. Usu ally o nly one met hod of test ing
each muscle is shown but, whe re ne cessa ry, mult iple illust rat ion s ha ve been include d if a
muscle has more th an one impo rta nt act io n. Th e examiner sho uld apply th e tes ts as they
are illustrated , becau se th e techniques show n will eliminate man y of t he tr ap s for t he
inexperience d provided by 'trick' movem en ts. It sho uld be noted that each of th e method s
used tests, as a ru le, the acti on of mu scles at a single joint.
When testing a movement, th e limb sh ould be firmly su pporte d proximal to the rel evant
joint, so that th e test is confi ned to the chose n muscle group and do es not require th e
patient to fix the limb proximally by mu scle co nt ract ion. In this book, thi s principle is
SPINAL ACCESSORY NERVE
l on g th or ac ic ne r ve t o serr at us an t erior
O::!
Mu scu lo c u ta neous
A x illary n erv e ."
-------- I
T2 -Jr::r::>
-e
r
RA DI AL N ERV E -.......-...... L'1
><
MEDIAN NE RVE cCIl
ULN AR NERVE - - CY
_ _ -::lY
M ed ia l c u t an eous nerve of fo rea rm Su bsca p u la r nerve s
M ed ial c u t aneous n erv e 0 1a rm t o su bsc apular is
'rh o rec c c c r se r nerve ' an d t er es m ajor
Fig. 3 Diagram of t he brachial plexus, it s bra nche s and t he muscles whic h th ey su pply.
BRACH IAL PLEXUS 5
fig.4 The approximate a rea wit hin which sensory cha nges ma y be fo und in complet e
lesions of t he bra chia l plexus (5. (6, (7. C8, T1).
Hg.5 The appr oximate area within which se nsory changes ma y be fou nd in lesions of t he
upper roots ( 5.(6) of t he brach ial plexus.
6 BRACH IAL PLEXUS
Fig.6 The approximate area wi t hin which sensory chang es may be found in lesions of th e
lower roo ts (C8. T1) of t he brachial plexus.
BRAC HIAL PLEXUS 7
Fig. 9 Pecto ralis Majo r: Clavicular Head {lateral pectora l nerve; ( S, (6)
The upper a rm is above th e ho rizonta l a nd t he pa tien t is push ing fo rwa rd agai nst the
examiner's hand. Arrow: t he clavicular head of pect oralis major can be seen and fel t .
Fig. 10 Pecto ralis Majo r: Ste rnocostal He ad (latera l and media l pe cto ral ne rves; (6, ( 7,
C8)
The patie nt is a dd uct ing the uppe r a rm ag a inst resistan ce .
Arrow: the sterno-costal head ca n be seen a nd fe lt.
BRACHIAL PLEXUS 9
..
Fig.13 lat issimu s Dorsi (Thor acod orsal ne rve ; ( 6, C7, C8)
The upper ar m is hor izontal and t he pat ient is addueting it against resista nce. Lo w er
arro w : t he muscle belly ca n be see n and felt. The upper a rrow points to teres major.
Brachialis
Fig. 16 Diagram of t he musculo cut aneous nerve, it s majo r cut aneous b ranch an d t he
muscles w h ich it supplies.
M USCULOTANEQUS N ERVE 13
Fig. 17 The ap proximate ar ea wi thin w hic h sensory cha nges may be found in lesions o f
the musculocutaneous nerve. (The distribution o f t he lat eral cutaneous nerve of t he
forearm.)
AXILlARY NERVE
UP PER CUTANEOUS
NE RVE OF THE ARM - - ----......., \J'-- - -i-- - - - RADIAL NERVE
minor
Fig _19 Diagram of the axillary nerve, its major cutaneous branch and the muscles wh ich
it suppnes.
o
f ig_20 The app ro xima te area w ithin w hich sensory changes may be fou nd in lesions of
the axillary nerve.
AXILLA RY NERVE 15
Fig.23 Diagram of t he radial nerve, it s major cutaneous branch and the muscles w hich it
suppli es.
RADIAL NERVE 17
Fig.24 The a pp ro xima te a rea within which sensory cha nges ma y be found in hig h les io ns
of the radi al nerve (above th e origi n of t he posterior cutaneou s nerves o f th e arm and
forearm). The ave rage area is usua lly considera bly smaller. and absence of sensory cha nges
has been recorded .
Fig.2S The approximat e a re a w ithin which se nso ry cha nges may be fo und in lesions of
the radial nerve above the elbo w joint and below the ori gi n of the posterior cutaneo us
nerve of the forearm. (The distr ib ut ion of the su perfici al t ermin al br anch of th e rad ial
nerve.) Usual a rea sha ded, with dark blue line; lig ht blue lines show small and large ar ea s.
18 KAlJIAL N EKVE
Fig. 30 Extensor Carp i Uln ar is {Poste r ior int ero sseous nerve; (7, ( 8)
The pat ien t is e xte ndi ng an d a dd ucti ng the ha nd a t t he wrist against resist an ce .
Arro ws: th e muscle belly and t he te ndon (a n be see n a nd felt .
Fig. 31 Ext ensor Digitoru m (Po st eri or intero sseous nerve; (7, C81
The patien t' s han d is firmly suppo rted by the exa mine r's rig ht ha nd. Ext e nsion at t he
metacarpopha langea l joints is ma intained a gainst the res ist a nce o f the fingers of t he
exemtner's left ha nd. A rr o w: t he muscle belly ca n be see n an d felt .
22 RADIAL NERVE
Fig_34 Extensor Poll id s Brevis (Posterior int erosseous nerve; C7. C8)
The patient is extending the thu mb at the metacarpophalangea l joint aga inst resistance.
Arrow: t he tendon ca n be seen and felt (d . Fig. 32).
MED IAN NERVE
IlL
I
Flexor poIhcis longus
)
Pronator quadratus ------+_
1\+ - - Palmar branc h
Motor Sensory
'd 't-- Flexor retinaculum
Abductor pomos
Flexor pollicis brevis _
Opponens poll icis - -- - tV
Firstlumbrical ------!'-J---'!ll!
Fig.35 Diagr am of t he median nerve. its cut aneous branches an d the muscles which it
su pplies . Note: th e white rectangle signifies that the muscle ind icat ed receives a part af its
nerve supply f rom another per ipheral nerve (d. Fig s. 45. 57 and 58).
MEDIAN NERVE 25
Fig.36 The app rox imate areas with in w h ich sensory changes may be fo und in lesion s of
the median nerve in: A t he fo rearm. B the carpal tunnel.
26 MEDIAN NERVE
Fig_39 fl exor Digi to ru m Superf icialis (M edian nerve ; C7, C8, Tt)
The pati ent is f lexing the f inger at th e proxima l int erphalageal joint against resistance
with t he proximal phalanx fixed . This test does not eliminate th e possibility of f lexion at
the pr oxim al inte r phalang eal jo in t being prod uced by flexor digit oru m profundus.
Fig.4O Flexor Digitoru m Pro fundus I and II (Anterior interosseous nerve; ( 7, (8)
The patien t is flexing the distal pha la nx of the ind ex finge r agai nst resista nce with the
middle phala nx fixed .
28 MEDIAN NERVE
Fig_41 Flexor Pol lid s l ongu s (Ante rior interosseou s nerve; 0. C8)
The patient is fle xing the distal phalan x of the t hu mb aga inst resist ance w hile t he
proximal phalanx is f ixed.
Fig _42 Abductor Polli cis Brevis (M edi an nerve; C8, 11)
The pat ie nt is abducting the thum b at fight ang les t o the palm aga inst re sista nce .
Arrow: t he muscle can be seen and fe lt.
M lJIAN NERVE 29
Fig. 44 lst lumb rical-Interosseous Muscle (Median and u lnar nerves; C8, 11 )
The pati ent is extendi ng the f inge r at t he p ro xim al inte rphalangeal joint aga inst
resista nce wit h t he metacar po phalange a l joint hyperextended a nd fixed .
ULNAR NERVE
I
I
- - - - - ULN AR NERVE
I
branch
Palmar cutaneous ,
branch
Deep m otor branch
- -- - Flexor carpi ulnaris
Superficial terminal
branches
I 11-- - - - Flexor digilorum
profund us III & IV
Mot or
Adductor ponies - - - - - - - - - - -0<.
Flexor pollicis brevis
} digiti minimi
Flexor
1st Dorsal interosseous
t st Palmar interosseous - - - - -/
Fig.4S Diag ram of t he ulnar nerve, it s cut aneous bra nches and the mu scles which it
supplies.
ULNAR NERVE 31
Fig_46 The approximate areas within which sensory changes may be found in lesions of
the ulna r nerve : A above the origin of t he do rsal cutaneous bran ch, B be low the origin of
the dorsal cutaneous branch and abo ve the origin of the pa lmar branch, C below the
origin of th e palmar b ranch.
32 ULNAR N ERVE
Fig.47 The app roxim at e area w it hi n w h ich sensory chang es may b e found in lesions of
the me di al cut aneous nerve of the fo rearm.
Fig. SO Flexor Digitorum Prof un dus III and IV (Ulnar nerve; 0 , C8)
The patient is flex ing the distal inte rphalangeal joint against resistance while the middle
phalanx is fixed.
34 ULNAR NERVE
Fig _53 r trst Dorsal Interosseous Muscle (Ul nar nerve; C8, 11)
The patient is abducting the index finger aga inst resistan ce.
Arrow. the muscle belly can be felt and usually see n.
Ili o inguina l ne r ve - - _ ,
P so as muscle
To lUaeus
Ge n ito le mo ra l nerve
10
levator a ni a nd
Su pe rio r a n d e xte rna l s p hl m::le,
int erior gluteal
Perineal ne rve
Dor sa l ner ve of
SCIATIC NERVE - - _ , penis or c li loris
Ner ve 10
s. rto rius mu s cle
Cutaneous nerv es
ot Ih igh
NERVE
branch es t o
______ Obtu ra to r e l le rn us
Addu ctor l ongu s
Adduct or brevi S
Ner v e s 10 quadric e p s
Addu ctor m a gnu s
Rectu s tem cr ta -----J. / - - - -- Gr ac ili s
VI Slu S l . t e ralis - - - - - \-J / - - - - C uta ne o us
Yu lus i n l er me dius ----\, - >.
V. Sl u S me d ia li s .. ne,v. c ut0an
1 t.ou
hig sh
Fig.56 Diagram of t he lumbosacral plexus, its branches a nd t he muscles which t hey supp ly.
NERVES OF THE LOWER LIMB
Iliacus
Adductor brevis
MEDIAL CUTA NEOUS
NERVe QFTHE T HIGH
1t-!lI-- - - - - - Adductor longus
Rectus femoris
1
\,
Quadriceps vas tcs l.ateraIiS.
semens
{
vastcs Intermedius - -/Y' L" .I I'. - - - - - - - - - Gracilis
Peroneus terlius - - - - - - - - -
Fig. 57 Diagram of the nerves on t he anterior aspect of t he lower limb, their cutaneous
branches and t he muscles w hich t hey supply.
NERVES OF THE LOWER LIMB 39
SUPERIOR GLUTEAL _
Tensor fasciae latae
Pir iformis
)
Gastrocnemius. medial head
Fig. 58 Diagram of the ne rves on the posterior aspect of the lowe r limb, th eir cutaneous
branches an d th e muscles which they suppl y.
40 NERVES OF TH E LOWER LIMB
.
Fig.59 The ap proxima te area within which se nsory changes may be found in lesion s of
t he la te ral cut an eous nerve of the th igh. Usua l area sha de d. wit h dark blue line; la rge
a rea indicated with light blue line .
..
Fig _60 The approximate area w ith in which sensory cha nges may be found in lesions of
the femoral nerve. (The distribution of the intermed iate and medial cutaneous nerves of
the t high and the saphenous nerve.)
NERVES OFTHE W WER LIMB 41
Fig. 61 The app roximate area within w hich sensory changes rna)' be found in lesio ns of
the obturator nerve.
Fig.62 The approximat e area w ithin w hich sensory changes may be found in lesions of
the post erio r cutaneous nerve o f the th igh.
42 NERVES OF THE WWER LIMB
Fig. 63 The app ro ximate area within w hich sensory changes may be found in lesions of
t he trun k of t he sciat ic nerve. (Mo dif ied from M.R.e. Special Report No. 54, 1920.)
Fig.64 The approximate ar ea within w hich sensory cha nges may be found in lesions of
bot h th e sciat ic and th e posterior cutaneous nerve of the t high.
NERVES OFTIIE LOWER LIM B 43
Fig. 65 The app roximat e area wit hin which sensory chan ges may be found in lesions of
the comm on peronea l nerve above the or igi n of the superficia l peron eal nerve. (Modified
from M.R.C. Special Report No. 54, 1920.)
J
Fig. 66 The approximate area wit hin which se nsory changes may be found in lesions of
th e deep peronea l nerve.
44 NERVES OF THE LOWER LIMB
Fig . 61 The approximate area within which sensory chan ges may be found in lesions of
t he su ral nerve.
Fig.68 The approximate a rea within w hich sensory cha nges may be found in lesions of
the t ibial nerve. (Modified f rom M.R.C. Specia l Report No. 54, 1920.)
NERVES OF TH E LOWER LIMB 45
+- - - - - CALCANEAL NERV E
Fig . 69 The approximate areas supplied by the cutaneous nerves to the sale of th e foot.
46 NERVES OF THE LOWER LIM B
J
}
Fig .70 Ilio psoas (Bra nches from l 1, 2 and 3 spinal nerves a nd femo ra l ne rve; l l , L2, l3)
The pat ient is fl exing the th igh at t he hip against resist ance wi t h th e leg fl exed at the
knee and hip .
,
I
Fig .72 Addu ct ors (Obt u rator nerv e; L2, l3, L4)
The patient lies on his back wi t h t he leg exte nded at t he knee. and is adducting th e limb
aga inst resist an ce. The muscle be llies can be felt .
Fig. 74 Gluteus Medius and Minimus and Tensor Fasciae Lat ae (Superior gluteal nerve; l 4,
LS, 5 1)
The pa t ien t lies o n his ba ck wit h the leg extended and is abducting the limb against
res istance. Arrows: t he muscle be llies can be felt and sometimes seen.
Fig. 76 Hamstring Muscles (Sciatic ne rve. Semitendinosus. semimem bra nosus and biceps;
L5. S1. S2)
The pa tien t lies o n his back w ith t he limb flexed at the hip a nd knee and is flexing t he le g
at the knee ag a inst resistance.
Fig.77 Ha mstring Musd es (Sdetic nerve . Sem iten d inos us, semime mbra nos us a nd bice ps;
l5, 51. 52)
The pat ient lies on his face and is flelCing the leg at t he knee aga inst resistance.
Arrows : t he t end ons of t he b icep s (laterally) and semitend inos us (medially) can be felt
an d usua lly see n.
SO NERVES O F THE LOWER LI MB
Fig. 81 Flexor Dig itor um l o ng us. Flexor Hettuos Long us (Tibial nerve; l 5, 51, 52)
The pa t ie nt is flexing the toes against resistance.
52 NERV ES OFTHE LOWER LIMB
Fig.82 Small muscles of th e f oot (medial and lateral plantar nerves; 51, 52)
The pat ient is cuppi ng t he sole of t he foot; the small muscles can be felt and someti mes
seen.
Fig. 84 Ext ensor Digit orum Longus (Deep peronea l nerve; l 5, 51)
The patie nt is dorsifl exin g t he toes ag ainst resistance . The ten dons passing to th e lateral
four toes can be seen and felt .
54 NERVES OF THE WWER LIMB
Fig.86 Extensor Digit orum Brevis (Deep peroneal nerve; LS, 51)
The patie nt is dorsifle xing the proxima l phala nges of the toes against res istance .
Arrow: the muscle belly ca n be fe lt a nd som etimes seen.
Fig.87 Perone us l o ngus and Brevis (Sup erficial pero neal nerve; r s. 51)
The pati ent is evert ing th e foo t against resist ance. Upper arr ow : th e tendon of pero neus
brevis. Lower arrow: t he tendon of pero neus lon gu s.
DERMATOMES
C'
T2
13
T'
T5
T7
T6
T9
TID
T11
T12
Ll
Fig. 88-9 1 show t he approx imate cutaneous areas supp lie d by each spina l root . There is
conside rable variat ion and overlap between der mat c mes, so t hat an isolate d root lesion
results in a much smalle r area of sensory imp airment than is indicated in t hese di agrams.
Th is var iation also applies t o t he innerv at ion o f t he f inger s, b ut th e t hu mb is usuall y
supplied by (6 and the little finge r usua lly by (8 (see Inouye and Bucht hal ( 1977) Bra;n
100: 13 1- 748).The heavy axial line s are usuall y mor e consist ent, show ing the boundary
between non consecutive dermat omes.
DERMATOMES 57
C4
T12
,/
L1
Fig.89 App roximate dist ribut io n of der matomes on t he po st e rior aspect of t he up per
limb.
58 DERMArOMES
Tt o
Tll
Tt 2
LI
I
SS r:>' SJ
L2
S2
l3
l3
S2
l5
l4
l4
I
l5
I
S,
L3 L3
52 52
53 53
L2
L2 L2
The list given be lo w does not include a ll t he muscles inne rvated by th ese nerves, but o nly
those mo re commonly tested , eithe r clinica lly o r e lectr ica lly, an d shows the o rde r of
innervation.
!
l ong head ]
Trice ps lateral he ad ( 6, ( 7, C8
Media l head
Brechioradialts ( 5. C6
Extensor carpi rad ialis longus ( 5. ( 6
Posterior Interosseous Nerve
Supinator ( 6, C7
Extensor carpi ulnaris C7, ( 8
Extensor dig itorum C7, (8
Abductor pollicis longus (7, (8
Extensor pollicis longus (7, (8
Extensor poll icis brevis (7, ( 8
Extensor in dicis (7, C8
M ed ian Nerve
Pron ator teres ( 6, (7
Hexer carpi radia lis C6, (7
Flexor di git or um superf tctens 0 , C8, T1
Abd uctor po llic is brevis C8, 11
Hexo r pollicis brevis" C8, 11
Op ponens pctncts C8, 11
lumbricals I & II C8, 11
NERVES AN D M AIN ROOT SUPPLY OF MUSCLES 61
Femoral Nerve
Iliopsoa s u . 12, L3
Rectus femori s ]
vestus taterehs Quadriceps L2. l3, l4
Vastus inte rm ed ius fe mo ris
Vast us med ia lis
Obturator Nerve
Add uctor longu5 12. l3, l 4
Adductor mag n us
Superior Gluteal Nerve
Gluteus med us and mi nimus l 4. L5, S1
Te nsor fasciae latae
In ferior Gluteaf Nerv e
Gluteus ma ximus l 5, 51, 52
Sciatic and Tibial Nerve s
Semit end in osus l5 , S1, S2
Biceps l5, 51, 52
Semimem branosus l 5, 51, 52
Gastr ocnem ius an d soleus 51, 52
Tib iali s post eri or l4, l 5
Flexor digitorum longus i s , 51, 52
Abductor hallu cis
Small mu scles
Abduct or digiti min imi 51, S2
o f fo ot
Intero ssei
Sciatic and Common Peron eal Nerves
Tibi alis ant erior l 4, l5
Extensor d ig it oru m longus l5, 51
Exte nsor hatlucis lo ngus l5, 51
Exte nsor d ig it orum br evis l5, 51
Perone us long us l 5, 51
Peroneus br evis l5. 51
* Flexor pollicis brev is is often supplied w holly or partially by t he u lnar nerve.
COMMONLY TESTED MOVEMENTS
Uppe r /i mb
Shou lder abduction ++ C5 Axilla ry Delto id
Elbow f lexion (5/6 + Musculocutaneous Biceps
C6 + Radia l are cbtor adtens
Elbow e xtension + C7 + Radia l Triceps
Radia l wrist extension + C6 Radial Ext ensor car pi
rad ia lis lo ng us
Finger ext ension + C7 Poste rior Extensor
int e rosse us ner ve d igit or um
commu nis
Fin g er f lex io n C8 + A nter io r Flexor polli ds
int er osseu s nerve lo ngus + Flexor
d igit or um
pro f u nd us
(i ndex)
Uln ar Flexo r d ig it oru m
prof und us
(ring + little)
Fin g er abd uction ++ T1 Ulnar First do rsal
interosseous
T1 Medi an Abduct or po ll icis
b revis
Low er limb
Hip fl exion ++ L1 /2 Iliopsoas
Hip adducti on L2I3 + Obturat or Addu ctors
Hip extensio n L51S1 Sciat ic Gluteus
ma ximu s
Knee f lexion + 51 Sciat ic Hamstrings
Knee extensi on L3/4 + Fem oral Quadriceps
Ankle dorsifl exion ++ L4 Deep peroneal Tib ial is anterior
An k le eversion LS151 Su pe rf icial peron eal Per onei
Ankle p lantarflexi on S1 152 + Tib ial Gastrocnemiu s,
soleus
Big t o e exte nsion L5 Deep pe roneal Extens or hellucis
longus
The t ab le shows some com mo n ly t ested movem ents, the principal muscle i nvo lved wi t h its
ro ots and ner ve su p ply. The colu m n he ad ed UMN indic at es those movements whic h ar e
preferentially w eak in uppe r motor neuron lesions.