Neurologic Quarter Screening
A neurological quarter screening exam is designed to assess symptoms extending below the gluteal
folds, below the upper trapezius or quarter symptoms of an unknown origin. The results of the
neurological examination will assist with differential diagnosis, and prognosis.
Sensory (Dermatomes)
Evaluation for sensory loss is performed during the quarter screen by lightly brushing the hand over
key dermatomal regions. Any deficit noted should be tested further with the use of a pin to clearly
map out the area of sensory deficit. General sensory loss may indicate either serious pathology or
possibly symptom magnification. Considerable overlap and individual variations in dermatomal
patterns are known to exist. The results of sensory testing should be collaborated with the results of
reflex and resisted testing to determine the presence and extent of nerve root compression.
Grading: Normal, Diminished or Absent
Motor (Resisted isometric testing)
Evaluation of key muscles to each myotome is performed. Myotomal weakness may be indicative of
lower motor neuron lesions, while more generalized weakness may indicate more serious pathology
or simply generalized disuse atrophy of the lower limb
Grading: Normal or Diminished
Reflex
Reflex assessment is used to evaluate the reflex pathway. Diminished or absent reflexes may be
indicative of nerve root impingement and subsequent lower motor neuron disturbance. Confirming
evidence that accompanies a diminished reflex would be myotomal weakness or sensation loss or
abnormality in a particular dermatome. Hyperactive reflexes in tendon reflexes can represent upper
motor neuron disturbances (e.g., myelopathy). At the same time, hyperactive reflexes can be a
normal variant. If encountered, the clinician should at least suspect a myelopathic process or an
upper motor neuron pathology. Confirming evidence for upper motor neuron involvement that
accompanies hyperactive reflexes would be pathological reflexes.
Grading: 0 Absent, 1+ Minimal response, 2+ Normal response, 3+ Brisk response, 4+ Hyperactive
reflex (Grades 0 and 4+ are indicative of pathology, 1+ and 3+ are normal unless asymmetric or
associated with other abnormalities)
Pathological reflexes are graded as positive or negative.
Upper Quarter Screen
Nerve
Root
C1
C2
C3
C4
C5
C6
Dermatome
No Dermatome
Back of head/occipital
region
Back of neck
Clavicle, AC joint
Lateral upper arm
Lateral forearm, palmar tip
of thumb or index finger
C7
Palmar tip of middle finger
C8
Palmar tip of little finger
T1
Medial forearm
T2
Medial upper arm
Myotome
Reflex
Pathological
reflexes
Cervical rotation
Hoffman reflex
Cervical flexion,
shoulder shrug
Shoulder shrug
Shoulder shrug
Shoulder abduction
Biceps
Elbow flexion or wrist
Brachioradialis
extension
Elbow extension or
Triceps
wrist flexion
Thumb extension
Finger adduction or little
finger abduction
Lower Quarter Screen
Nerve
Root
L1
L2
L3
L4
Dermatome
Inguinal ligament
Anterior proximal thigh
Anterior distal thigh and
medial knee
Medial lower leg
L5
Lateral lower leg, dorsum
of foot
S1
Lateral foot, heel
S2
Posterior knee –popliteal
fossa
Myotome
Hip flexion
Hip flexion
Knee extension
(2° hip adduction)
Dorsiflexion
Great toe extension (2°
hip abduction)
Functional heel walking
Eversion , plantarflexion
(2° knee flexion, hip
extension)
Functional toe walking
Bowel/bladder problems
Reflex
Pathological
reflexes
Ankle clonus
Babinski
Patellar tendon
Achilles’ tendon