MSK Examination Routines


Myotomes (msk)


Each muscle in the body is supplied by a particular level or segment of the spinal cord and by its corresponding spinal nerve. The muscle, and its nerve make up a myotome.

Myotomes — not quite right
C345 diaphragm
C5 deltoid
C6 wrist extension
C7 elbow extension
C5 shoulder abduction & lateral rotation
C7 shoulder adduction & Medial rotation
C6-7: wrist flexion/extension
C5-6 elbow flexion
C7-8: elbow extension
C6: Pronation/Supination
C8 finger flexion
T1 fingers abduction
C7-8: finger Flexion/Extension
T1: Abduction/Adduction (small muscles of the hand)
T1 –T12 the chest wall & abdominal muscles

L123 hip flexion – iliopsoas  (+adduction and medial rotation)
L45   hip Extension  glutei (+abduction and lateral rotation)
L34   knee extension quadriceps
L5S1 knee flexion
L4-5 ankle and foot dorsiflexion
S1-2 ankle and foot plantarflexion (gastrocnemius)
L4 ankle inversion (tibialis anterior and posterior)
L45   ankle dorsiflexion
L5-S1 ankle eversion  (peronei)
L5S1    toe extension
S1 S2   toe flexion
S3 4 5 bladder bowel genitalia and the anal and other pelvic muscles.


Tendon Reflexes

biceps C5/6
triceps C6/C7
supinator C5/C6
knee L3/L4
ankle L5/S1

Test for clonus if hyperreflexia present/suspected
Hyperreflexia – UMN, thyrotoxicosis, uraemia, hepatic coma
Hyporeflexia – LMN, myopathies, acute UMN damage

Reinforcement – ask patient to clench teeth ( for upper limb reflexes) or clench hands and pull in opposite directions (lower limb reflexes)

Plantar Reflex L5/S1 – elicited by stroning lateral border of sole of foot. Flexor in normal patients, extensor (Babinski) in UMN

Upgoing plantars and absent ankle jerks – SACD, DM, Friederichs, taboparesis, MND

Delayed relaxation – hypothyroisism.

Pendular jerks – cerebellar lesions.




MRC MSK Scales (msk)


MRC scale for strength of muscle contraction
5/5 normal FROM against gravity with full resistance
4/5 good FROM against gravity with moderate resistance
3/5 fair FROM against gravity only
2/5 poor FRO passive movement (gravity eliminated)
1/5 trace of muscle contraction (palpable) but without joint movement
0/5 zero no evidence of muscle contraction


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