LOWER CERVICAL

Fifth Cervical

Seventh Cervical

Pa in

Atrophy

Tender

Eighth Cervical

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LUMBOSACRAL

Fourth Lumbar

Num b Sen sat ion

Second Sacral
PAIN in medial gluteal fold
TENDERNESS over upper lateral
sacrum
S2
RADIATION of pain to posteromedial thigh, leg and heel.
NUMB sensation medial gluteal fold,
labium major or scrotum.
HYPOALGESIA as outlined.
REFLEX plantar flexion response reduced.
MOTOR WEAKNESS non recognized.

Pain

h
At ro p

Pa in

PAIN in medial gluteal (hip) region

(over ischial tuberosity).
TENDERNESS over transverse
process of vertebra
RADIATION of pain to posterior
thigh & leg.
NUMB sensation posterior leg, little toe.
HYPOALGESIA as outlined.
REFLEX of achilles tendon reduced or absent.
MOTOR WEAKNESS & ATROPHY
of plantar flexors.

Num b Sen sat ion

ti o n

First Sacral

PAIN in gluteal (hip) region between ischial tuberosity

& greater trochanter.
TENDERNESS over transverse process
of vertebra.
RADIATION of pain to lateral thigh
and leg.
NUMB sensation lateral leg, three
middle (or great) toes.
HYPOALGESIA as outlined. Atrophy
REFLEX usually no alteration.
MOTOR WEAKNESS & ATROPHY
of dorsal flexors of ankle and toes.

Num b S en sa

Fifth Lumbar

Pain

Pain

PAIN over medial scapular spine.

TENDERNESS over transverse
Atrophy
process of vertebra.
RADIATION of pain to posteromedial arm.
NUMB sensation 5th & 5th digits.
HYPOALGESIA as outlined.
MOTOR WEAKNESS & ATROPHY Numb Sensation Pai n
of intrinsic muscles of hand.

PAIN upper medial scapula.

TENDERNESS over transverse
process of vertebra.
RADIATION of pain to posterolateral arm.
Atrophy
Pa i n
NUMB sensation 2nd & 3rd digits. Numb
HYPOALGESIA as outlined.
REFLEX of Triceps tendon
reduced or absent.
MOTOR WEAKNESS & ATROPHY
of Triceps muscle.

PAIN in gluteal (hip) region over trochanter.

TENDERNESS over transverse process
of vertebra.
RADIATION of pain to anterior
thigh & leg.
NUMB sensation anterior leg, great toe.
HYPOALGESIA as outlined.
REFLEX of patellar tendon reduced
or absent.
MOTOR WEAKNESS & ATROPHY
of quadriceps muscle.

b
Numat io n
s
Se n

PAIN upper medial scapula.

TENDERNESS over transverse
process of vertebra.
RADIATION of pain to internal arm.
NUMB sensation of thumb.
HYPOALGESIA as outlined.
REFLEX of Biceps tendon
reduced or absent
MOTOR WEAKNESS
& ATROPHY of thumb,
biceps and scapular muscles.

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PAIN upper border scapula.

TENDERNESS over transverse
process C4-5 vertebras.
RADIATION of pain to anteroAtrophy
lateral arm.
Winged Scapula
NUMB sensation anterolateral
forearm.
HYPOALGESIA as outlines
(more evident distally)
Pa in
REFLEX of biceps tendon reduced.
MOTOR WEAKNESS AND ATROPHY of Serratus Magnus
(winged scapula) and Anterior Deltoid Muscles.

Sixth Cervical

Num b
Se ns at ion

Pa i n

Numb Sensation

Adapted from Keegan JJ: Variations of symptoms with herniation of intervertebral discs. Nebraska MJ 43:191, 1958.