This document provides information about performing a neurological exam of the upper and lower extremities. It lists the spinal nerve roots and their corresponding dermatomes, muscles innervated, primary motions, and reflexes. For the upper extremities, it examines C5-T1 nerve roots and for the lower extremities it examines L1-S4 nerve roots. It also describes provocative tests for the lower extremities including the crossed straight leg raise test and Babinski's test to evaluate for upper motor neuron lesions.

1. NEUROLOGICAL EXAM

2. Upper Extremity Neuro Exam
Root Sensory Muscles Primary Motion Reflex
C5
Lateral
shoulder
Deltoid
Biceps
Shoulder
abduction
Elbow flexion
(palm up)
Biceps
C6 Thumb
Brachioradialis
ECRL
Elbow flexion
(thumb up)
Wrist extension
Brachioradialis
C7
Middle
finger
Triceps
FCR
Elbow extension
Wrist flexion
Triceps
C8
Ring &
small
fingers
FDS
Finger flexion,
hand grip, thumb
extension
-
T1
Ulnar
forearm
& hand
Intrinsic
muscles
Finger abduction -

3. Upper Extremity Neuro Exam - PROVOCATIVE TESTS

4. Upper Extremity Neuro Exam - PROVOCATIVE TESTS

5. Upper Extremity Neuro Exam - PROVOCATIVE TESTS

6. Lower Extremity Neuro Exam
Root Sensory Muscles Primary Motion Reflex
L1
Iliac crest and
groin
Cremasteric
reflex
L2
Anterior and
inner thigh
Iliopsoas
(lumbar
plexus,
femoral n.)
Hip adductors
(obturator n.)
Hip flexion and
adduction
L3
Anterior &
medial thigh
Quadriceps
(femoral n.)
Knee extension -
L4
Medial leg &
ankle
Tibialis
anterior
Ankle
dorsiflexion
Patellar tendon
(“knee jerk”)
L5
Dorsal foot &
1st web space
Extensor
hallucis longus
Toe dorsiflexion -

7. Lower Extremity Neuro Exam
Root Sensory Muscles Primary Motion Reflex
S1
Lateral &
plantar foot
Gastrocnemius
(tibial n.)
Ankle
plantarflexion
Achilles tendon
(“ankle jerk”)
S2
Plantar foot
Perianal
sensation
FHL (tibial n.),
FDL (tibial)
Anal sphincter
Toe
plantarflexion
Anal squeeze
Bulbocavernosus
S3
Perianal
sensation
Anal sphincter
Bladder
Bowel &
bladder
function
Anal squeeze
S4

8. Lower Extremity Neuro Exam - PROVOCATIVE TESTS
Crossed Straight Leg Raise
• Performing straight leg raise in uninvolved leg produces symptoms in involved leg

9. Lower Extremity Neuro Exam - PROVOCATIVE TESTS
Babinski's Test
• Positive findings suggests upper motor neuron lesion
Ankle Clonus Test
• associated with upper motor neuron lesion