I always find it interesting to look at these dermatomes body map images showing where the functions are affected. It just helps to make sense i guess...
My apologies guys, I have only just caught up with the threadDJ,cbdives,wavewolf.
Ive posted this information so we have a comparison. These are the most recent standards that I can find:International standards for neurological classification of spinal cord injury (Revised 2011) SOURCE C2 –At least 1 cm lateral to the occipital protuberance (alternatively 3 cm behind the ear) C3 –Supraclavicular fossa (posterior to the clavicle) and at the midclavicular line C4 –Over the acromioclavicular joint C5 –Lateral (radial) side of the antecubital fossa (just proximal to elbow crease) C6 –Thumb, dorsal surface, proximal phalanx C7 –Middle finger, dorsal surface, proximal phalanx C8 –Little finger, dorsal surface, proximal phalanx T1 –Medial (ulnar) side of the antecubital) fossa, just proximal to the medial epicondyle of the humerus T2 –Apex of the axilla T3 –Midclavicular line and the third intercostal space (IS) found by palpating the anterior chest to locate the third rib and the corresponding IS below it* T4 –Fourth IS (nipple line) at the midclavicular line T5 –Midclavicular line and the fifth IS (midway between T4 and T6)T6 –Midclavicular line and the sixth IS (level of xiphisternum) T7 –Midclavicular line and the seventh IS (midway between T6 and T8) T8 –Midclavicular line and the eighth IS (midway between T6 and TI0) T9 –Midclavicular line and the ninth IS (midway between T8 and T10) T10 –Midclavicular line and the tenth IS (umbilicus) T11 –Midclavicular line and the eleventh IS (midway between T10 and Tl2) T12 –Midclavicular line and the mid-point of the inguinal ligament L1 –Midway distance between the key sensory points for Tl2 and L2L2 –On the anterior-medial thigh at the midpoint drawn connecting the midpoint of inguinal ligament (T12) and the medial femoral condyle L3 –Medial femoral condyle above the knee L4 –Medial malleolus L5 –Dorsum of the foot at the third metatarsal phalangeal joint S1 –Lateral heel (calcaneus) S2 –Mid point of the popliteal fossa S3 –Ischial tuberosity or infragluteal fold S4–5 –Perianal area less than one cm. lateral to the mucocutaneous junction (taken as one level)
*An alternative way of locating T3 is palpating the manubriosternal joint, which is at the level of the second rib. At that point, move slightly lateral to palpate the second rib and continue to move in a caudal direction to locate rib three and the corresponding intercostal space just below it.
Deep Anal Pressure (DAP): DAP awareness is examined through insertion of the examiners index finger and applying gentle pressure to the anorectal wall (innervated by the somatosensory components of the pudendal nerve S4/5). Alternatively, pressure can be applied by using the thumb to gently squeeze the anus against the inserted index finger. Consistently perceived pressure should be graded as being present or absent (i.e., enter Yes or No on the worksheet). Any reproducible pressure sensation felt in the anal area during this part of the exam signifies that the patient has a sensory incomplete lesion. In patients who have light touch or pin prick sensation at S4-5, evaluation of DAP is not necessarily required as the patient already has a designation for a sensory incomplete injury, although still recommended to complete the worksheet. The rectal examination is still required however, to test for motor sparing (i.e. voluntary anal sphincter contraction).
Sensory examination: optional elements
For purposes of the SCI evaluation, the following aspects of sensory function are considered as optional: joint movement appreciation and position sense, and awareness of deep pressure/deep pain. (Note: there is no specific portion for this to be recorded on the worksheet except for the comments section). Joint movement appreciation and position sense are graded using the same sensory scale provided (absent, impaired, normal). A grade of 0 (absent) indicates the patient is unable to correctly report joint movement on large movements of the joint. A grade of 1 (impaired) indicates the patient is able to consistently report joint movement with 8 of 10 correct answers – but only on large movements of the joint and unable to consistently report small movements of the joint. A 2 (normal) indicates the patient is able to consistently report joint movement with 8 out of 10 correct answers on both small (approximately 10° of motion) and large movements of the joint. Joints that can be tested include the interphalangeal (IP) joint of the thumb, the proximal IP joint of the little finger, the wrist, the IP joint of the great toe, the ankle, and the knee. Deep pressure appreciation of the limbs (applying firm pressure to the skin for 3–5 seconds at different locations of the wrist, fingers, ankles and toes) can be tested for patients in whom light touch and pin prick modalities are graded as 0 (absent). Because this test is electively performed in the absence of light touch and pin prick sensation, it is graded as either a 0 for absent, or 1 for present, in reference to firm pressure, using the index finger or thumb, to the chin.
Motor examination: required elements
The required portion of the motor examination is completed through the testing of key muscle functions corresponding to 10 paired myotomes (C5-T1 and L2-S1) (see later). It is recommended that each key muscle function should be examined in a rostral-caudal sequence, utilizing standard supine positioning and stabilization of the individual muscles being tested. Improper positioning and stabilization can lead to substitution by other muscles, and will not accurately reflect the muscle function being graded.
The strength of each muscle function is graded on a six-point scale1,6,7,9
0 = total paralysis. 1 = palpable or visible contraction. 2 = active movement, full range of motion (ROM) with gravity eliminated. 3 = active movement, full ROM against gravity. 4 = active movement, full ROM against gravity and moderate resistance in a muscle specific position. 5 = (normal) active movement, full ROM against gravity and full resistance in a muscle specific position expected from an otherwise unimpaired person. 5* = (normal) active movement, full ROM against gravity and sufficient resistance to be considered normal if identified inhibiting factors (i.e. pain, disuse) were not present.
NT= not testable (i.e. due to immobilization, severe pain such that the patient cannot be graded, amputation of limb, or contracture of >50% of the range of motion). Plus and minus scores are not used when the International Standards examination is applied in a research setting and not recommended when comparing data across institutions.
In cases of a muscle function whose ROM is limited by a contracture, if the patient exhibits ≥50% of the normal range, then the muscle function can be graded through its available range with the same 0–5 scale. If the ROM is limited to <50% of the normal ROM, “NT” should be documented. C5 –Elbow flexors (biceps, brachialis) C6 –Wrist extensors (extensor carpi radialis longus and brevis) C7 –Elbow extensors (triceps) C8 –Finger flexors (flexor digitorum profundus) to the middle finger T1 –Small finger abductors (abductor digiti minimi) L2 –Hip flexors (iliopsoas)L3 –Knee extensors (quadriceps) L4 –Ankle dorsiflexors (tibialis anterior)L5 –Long toe extensors (extensor hallucis longus) S1 –Ankle plantar flexors (gastrocnemius, soleus)
When testing for a grade 4 or 5 strength the following specific positions should be used. Please refer to the InSTeP training or the muscle function testing downloads for details for grades 0–3 testing15.
C5 –Elbow flexed at 90 degrees, arm at the patient's side and forearm supinated
C6 –Wrist in full extension
C7 –Shoulder is neutral rotation, adducted and in 90 degrees of flexion with elbow in 45 degrees of flexion
C8 –Full flexed position of the distal phalanx with the proximal finger joints stabilized in a extended position
T1 –Full abducted position of fingers
L2 –Hip flexed to 90 degrees
L3 –Knee flexed to 15 degrees
L4 –Full dorsiflexed position of ankle
L5 –First toe fully extended
S1 –Hip in neutral rotation, neutral flexion/extension, and neutral abduction/adduction, the knee is fully extended and the ankle in full plantarflexion
I will take a look over the next couple of days at the comparisons
Lαrα, Thank you--this is one of the most useful listings I have seen. I will try to find the ones I had memorized, for comparison to original post. Struggling now just to do ADLs...