what does the grade of joint movement of S1/T1/L2 indicate?

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dwaters1 | Middle School Teacher | eNotes Newbie

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Neurologic level of injury

The NLOI is defined as the most caudal (ie, lowest) level of the spinal cord that has normal motor and sensory function. The motor level, which is a better predictor of the patient's functional abilities, is determined by the manual testing of key muscle groups on both sides of the body. These groups represent neurologic levels, and findings are graded 0-5, as follows:

  • Grade 5 - Normal; muscle movement through the complete range of motion (ROM) against gravity and full resistance
  • Grade 4 - Good; muscle movement through the complete ROM against gravity and moderate resistance
  • Grade 3 - Fair; muscle movement through the full ROM against gravity alone
  • Grade 2 - Poor; muscle movement through the full ROM with gravity eliminated
  • Grade 1 (Trace) - Palpable muscle contraction or joint movement, but not through complete ROM, even with gravity eliminated
  • Grade 0 - Zero; no muscle movement or palpable contraction

Motor levels representing upper and lower extremity function (and key muscles) are as follows:

  • C5 - Elbow flexion (biceps)
  • C6 - Wrist extension (extensor carpi radialis)
  • C7 - Elbow extension (triceps)
  • C8 - Finger flexion (flexor digitorum profundus)
  • T1 - Small finger abductors (abductor digiti minimi)
  • L2 - Hip flexion (iliopsoas)
  • L3 - Knee extension (quadriceps)
  • L4 - Ankle dorsiflexion (tibialis anterior)
  • L5 - Great toe extension (extensor hallucis longus)
  • S1 - Ankle plantar flexion (gastrocsoleus complex)

Sensory function is determined by examining 28 key sensory points on both sides of the body. These points are designated within dermatomes for light touch and pin prick. They are graded as follows: 2 = normal, 1 = impaired, and 0 = absent.

Sensory levels are designated as follows:

  • C2 - Occipital protuberance
  • C3 - Supraclavicular fossa
  • C4 - Top of acromioclavicular joint
  • C5 - Lateral antecubital fossa
  • C6 - Thumb
  • C7 - Middle finger
  • C8 - Little finger
  • T1 - Medial antecubital fossa
  • T2 - Apex of axilla
  • T3 - Third intercostal space (IS)
  • T4 - Fourth IS (nipple line)
  • T5 - Fifth IS (midway T4-T6)
  • T6 - Sixth IS (xiphisternum)
  • T7 - Seventh IS (midway T6-T8)
  • T8 -  Eighth IS (midway T6-T10)
  • T9 - Ninth IS (midway T8-T10)
  • T10 - Tenth IS (umbilicus)
  • T11 - 11th IS (midway T10-T12)
  • T12 - Inguinal ligament (midpoint)
  • L1 - Half the distance T12-L2
  • L2 - Midanterior thigh
  • L3 - Medial femoral condyle
  • L4 - Medial malleolus
  • L5 - Dorsum of foot (3rd metatarsophalangeal joint)
  • S1 - Lateral heel
  • S2 - Popliteal fossa (midline)
  • S3 - Ischial tuberosity
  • S4-5 - Peri-anal area

ASIA Impairment Scale

The ASIA Impairment Scale classifies the completeness of SCI on a scale from A-E, as follows2,3,4,5 :

  • A - Complete; no sacral motor or sensory sensation in segments S4-5
  • B - Sensory incomplete; preservation of sensation below the level of injury, extending through sacral segments S4-5
  • C - Motor incomplete; voluntary anal sphincter contraction or sensory sacral sparing with sparing of motor function distal to 3 levels below the motor level of injury, with the majority of key muscles having a strength grade of less than 3
  • D - Motor incomplete; voluntary anal sphincter contraction or sensory sacral sparing with sparing of motor function distal to 3 levels below the motor level of injury, with the majority of key muscles having a strength grade of 3 or greater
  • E - Normal; normal motor and sensory recovery (hyperreflexia may be present)

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