nerve root

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Introduction

One of the 2 bundles or nerve fibers emerging from the spinal cord (dorsal & ventral roots). They join to form a single spinal nerve after relay in the dorsal root ganglia. Cranial nerve 5 is similarly formed from 2 roots.

Nerve roots innervating muscles

C1-C2  sternocleidomastoid
C2-C4  trapezius
C3-C5  diaphragm
C5-C6  supraspinatus, infraspinatus, deltoid, biceps, brachialis, brachioradialis, supination of forearm
C5-C7  serratus
C6-C7  triceps, radial deviation of wrist
C6-C8  extensors of wrist & metacarpophalangeal joints, pronation of forearm
C7-C8  wrist flexors, ulnar deviation of wrist, flexor & abductor pollicis brevis
C8     thumb opposition, interossei, lumbricals
T1-T12 innervate the trunk (thorax & abdominal walls.)
L2-L3     iliopsoas, hip flexions
L2-L4     quadriceps, thigh adductors
L4        deep tendon reflex at knee tests L4
L4-L5     tibialis anterior (walking on heels tests function)
L4,L5     gluteus medius
L5        extensor hallicus longus, great toe dorsiflexion
L5-S1     peroneus longus, peroneus brevis
L5-S1     gluteus maximus
L5,S1-S2  biceps femoris, soleus, gastrocnemius
S1        walking on toes tests function
S1-S2     short plantar
S2-S3     smooth muscles of urinary bladder
S3-S5     perineal muscles

Sensory findings of nerve root involvement*

C3 (C2-C3)  pain into the back of neck to the pinnae of the ear & the angle of the jaw
C4 (C3-C4)  pain into the back of neck to the levator scapulae to the anterior chest
C5 (C4-C5)  pain into the side of the neck to the superior lateral shoulder; numbness over the deltoid
C6 (C5-C6)  pain to the lateral aspects of the arm & forearm & into the thumb & index finger with numbness of the thumb & dorsum of hand
C7 (C6-C7)  pain into the midforearm to middle & ring fingers
C8 (C7-C8)  pain into the medial aspect of the forearm into the ring & small fingers with numbness of the ulnar border & small finger
L4 (L3-L4)  pain in sacroiliac joint, hip, posterolateral thigh, anterior aspect of leg, L4 dermatome
L5 (L4-L5)  pain in sacroiliac joint, hip, L5 dermatome (includes great toe)
S1 (L5-S1)  pain in lateral aspect of leg & foot, S1 dermatome (includes lateral toes)

* Nerve root & (disc level)

Motor findings of nerve root involvement*

C3 (C2-C3)  no reflex changes
C4 (C3-C4)  no reflex changes
C5 (C4-C5)  deltoid muscle atrophy & weakness of shoulder abduction
C6 (C5-C6)  weak biceps & brachioradialis muscles; decreased biceps & brachioradialis tendon reflexes
C7 (C6-C7)  triceps muscle weakness with decreased triceps muscle reflex
C8 (C7-T1)  triceps muscle weakness with weakness of intrinsic muscles of hand

* Nerve root & (disc level)

C3 (C2-C3)  pain into the back of neck to the pinnae of the ear & the angle of the jaw
C4 (C3-C4)  pain into the back of neck to the levator scapulae to the anterior chest
C5 (C4-C5)  pain into the side of the neck to the superior lateral shoulder; numbness over the deltoid
C6 (C5-C6)  pain to the lateral aspects of the arm & forearm & into the thumb & index finger with numbness of the thumb & dorsum of hand
C7 (C6-C7)  pain into the midforearm to middle & ring fingers
C8 (C7-C8)  pain into the medial aspect of the forearm into the ring & small fingers with numbness of the ulnar border & small finger
L4 (L3-L4)  pain in sacroiliac joint, hip, posterolateral thigh, anterior aspect of leg, L4 dermatome
L5 (L4-L5)  pain in sacroiliac joint, hip, L5 dermatome (includes great toe)
S1 (L5-S1)  pain in lateral aspect of leg & foot, S1 dermatome (includes lateral toes)

* Nerve root & (disc level)

Motor findings of nerve root involvement*

C3 (C2-C3)  no reflex changes
C4 (C3-C4)  no reflex changes
C5 (C4-C5)  deltoid muscle atrophy & weakness of shoulder abduction
C6 (C5-C6)  weak biceps & brachioradialis muscles; decreased biceps & brachioradialis tendon reflexes
C7 (C6-C7)  triceps muscle weakness with decreased triceps muscle reflex
C8 (C7-T1)  triceps muscle weakness with weakness of intrinsic muscles of hand

* Nerve root & (disc level)

More general terms

Additional terms

References

  1. B. Ourmazdi, M.D. Synopsis of Neurology & Examination, B & B Books, Saratoga, CA, 1998
  2. Principles of Ambulatory Medicine, 4th edition, Barker et al (eds), Williams & Wilkins, Baltimore, 1995, pg 864, 879
  3. Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999