Emergency Medicine

NECK INJURIES

Surgical Emergencies 225

3 Palpate for areas of tenderness, swelling or deformity in the neck. Assess for
limb tone, weakness, ref lex loss and sensory deficit, including loss of perineal
sensation and anal tone.

4 Describe any motor weakness found by the myotome and ref lex abnormali-
ties:
(i) Myotomes in the upper limb. Nerve roots C5 to T1 supply the
muscles of the upper limb (see Table 8.3).

(ii) Use the Medical Research Council scale to grade muscle

weakness, so that the same terminology is used by each doctor

examining the patient (see Table 8.4).

(iii) Reflexes in the upper limb: assess for the biceps, triceps and

supinator upper limb reflexes, which indicate normal or other

functioning of certain motor roots (see Table 8.5 for motor roots

of the reflexes)

Table 8.3 Myotomes in the upper limb and their associated actions

Root Action

C5 Shoulder abduction

C6, C7 Shoulder adduction

C5, C6 Elbow flexion

C7 Elbow extension

C6 Pronation and supination

(C6), C7 Wrist flexion

C6, (C7) Wrist extension

C8 Finger flexion

C7 Finger extension

T1 Intrinsic hand muscles

Table 8.4 Medical Research Council (MRC) scale used to grade muscle weakness

Recorded grade Physical finding

Grade 0 Complete paralysis

Grade 1 A flicker of contraction only

Grade 2 Movement possible only if gravity is eliminated

Grade 3 Movement against gravity

Grade 4 Movement against gravity and resistance

Grade 5 Normal power