UNC's Online Neurosurgery Resident's Handbook - Spinal Root Syndromes

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Root Sensation Index Muscle Reflex Comments
C3/4 Pain or hypalgesia in shoulders Paresis of diaphragm, occasionally rhomboids None C3 anterior diaphragm, C4 posterior diaphragm
C5 Pain or hypalgesia laterally over upper arm and shoulders Paresis of deltoid, supraspin-atus, infra- spinatus, rhomboids Diminished biceps reflex Common causes include brachial neuritis, upper plexus injury, cervical spondylosis
C6 Pain or hypalgesia of radial forearm, thumb, and index finger Paresis of biceps, brachialis, brachiorad-ialis, Extensor carpi radialis Diminished biceps, brachiorad ialis reflex Common causes include spondylosis, acute disc lesion (20%)
C7 Pain or hypalgesia over triceps, mid- forearm and middle finger Paresis of triceps, latissimus dorsi, pectoralis major, ext. carpi ulnaris , flex. carpi radialis Diminished or absent triceps reflex Common causes includes acute disc lesions (70%), spondylosis, DDX includes CTS (triceps reflex present)
C8 Pain or hypalgesia over ulnar forearm, 4th/5th digits Paresis of flex. dig. sup. & profundus, flex. poll. longus, flex. carpi ulnaris Diminished finger jerk (Hoffmans or Tromner) Caused rarely by spondylosis or acute disc lesion; DDX includes ulnar nerve palsy
T1 Pain or hypalgesia from axilla to olecranon Paresis of all small hand muscles and hypothenar wasting None Common causes include outlet syndrome, pancoast tumor, metastatic Ca of deep cervical nodes
L3 Pain or hypalgesia across upper anterior thigh Paresis of quadriceps femoris Patellar reflex decreased or absent DDX includes femoral nerve palsy
L4 Pain or hypalgesia from lateral thigh, over patella to medial calf and inner foot Paresis of quadriceps femoris, and tibialis anterior Patellar reflex diminished 5% lumbar discs, DDX includes femoral nerve palsy
L5 Pain or hypalgesia from postero-lateral thigh to lateral calf to dorsum of foot Paresis of EHL, occ EDB Posterior tibial reflex decreased; useful only if elicitable on other side 40% lumbar discs; DDX includes peroneal nerve palsy
S1 Pain or hypalgesia from posterior thigh down to lateral aspect and sole of foot Paresis of triceps surae, hamstrings, gluteus maximus Achilles tendon reflex decreased 45% lumbar discs

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