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Dr. Ebraheim’s educational animated video describes neurological examination of the lumbar spine nerve roots. Neurological evaluation of the lumbar nerve roots. To study the involvement of any nerve root, we look for sensory changes, motor changes and reflex changes. If there is a herniated disc between T12 and L1, it will affect the L1 nerve root. Let us see what changes we can find if the L1 nerve root is affected. We'll start with the sensory. The sensation of L1 is half the distance between the inguinal ligament and mid thigh. Motor, hip flexion. It comes from the iliopsoas, L1, L2 and L3. There is no reflex for L1. Disc herniation between L1 and L2, it will affect the L2 nerve root. The sensory changes will be in L2 mid anterior thigh. The motor will be hip flexion, L1, L2 and L3. Hip adduction is L2, L3 and L4. Knee extension is L2, L3 and L4. There is no reflex for L2 nerve root. How about a disc herniation between L2 and L3? It will affect the L3 nerve root. The sensation of L3 will be the distal part of the thigh, including the knee area as illustrated in this diagram. The motor: hip flexion, L1, L2 and L3. Hip adduction, L2, L3 and L4. And knee extension, L2, L3 and L4. There is no reflex for L3. A herniated disc between L3 and L4. It will affect the L4 nerve root. The sensation of L4 is illustrated in this diagram to be in the medial side of the leg down to the medial side of the foot. The L4 motor will be an ankle dorsiflexion and we usually test the ankle dorsiflexion, the tibialis anterior and knee extension. It's involved in L4. A positive femoral stretch test can also be seen in L4 nerve root involvement. The test is positive if pain is felt in the ipsilateral anterior thigh and if the test is positive, it means there is probably a disc herniation between L3 and L4 affecting L4 nerve root. Reflexes. The patellar reflex is mainly L4. A disc herniation between L4 and L5, it will affect the L5 nerve root. The sensation will be the dorsum of the foot and the leg. The motor will be hip abduction, the gluteus medius and big toe extension. The L5 nerve root is very popular in the exam, so they will give you a scenario. If you see a big toe extension, that's an L5 nerve root. It is four and five disc herniation. They can give you Trendenberg gait. That's an L5 nerve root, gluteus medius and minimus because of disc herniation between L4, L5 will affect L5 nerve root, so both muscles are supplied by L5 nerve root. Straight leg raise can be positive when there's irritation of L5 nerve root. This test is used to determine if the patient with low back pain has an underlying herniated disc irritating the nerves. Herniated disc between L5 and S1. It will affect the S1 nerve root. The sensory of S1 will be the lateral and plantar aspect of the foot. How about the motor? It's hip extension gluteus maximus. We don't use that a lot, but ankle plantar flexion, the gastrocnemius complex, is the one we use. And we also use foot eversion, the peroneus longus and brevis. We also use the positive straight leg raise. We use that exam, as I mentioned earlier, to determine if the patient with low back pain has an underlying component of a herniated disc or not. And we call that the stretch test. And the reflexes, the S1 will give you the ankle reflex. So there are three important nerve roots, L4, L5 and S1, and you can check three things. The sensory, the motor and the reflexes. If we take the motor, for L4 it's an ankle dorsiflexion. For L5, the big toe or the hip abductors, the gluteus medius and minimus. The S1, ankle plantar flexion. Sensation. Medial side of the foot is L4. Top of the foot is L5. Lateral side of the foot is S1. This is really how we examine the patients. Reflexes. Patellar reflex, mainly L4. Ankle reflex is S1. 1. What nerve root is affected by a herniated disc between L3 and L4? A) L2 B) L4 C) L5 D) S1 Answer: L4 Explanation: A disc herniation between L3 and L4 compresses the L4 nerve root, causing characteristic sensory, motor, and reflex changes. 2. Which motor function is associated with the L5 nerve root? A) Ankle plantar flexion B) Big toe extension C) Knee extension D) Ankle dorsiflexion Answer: Big toe extension Explanation: Big toe extension (extensor hallucis longus) and hip abduction (gluteus medius and minimus) are key indicators of L5 nerve root involvement. 3. The patellar reflex predominantly tests which nerve root? A) L3 B) L5 C) S1 D) L4 Answer: L4 Explanation: The patellar tendon reflex mainly assesses the integrity of the L4 nerve root. 4. Which sensory area corresponds to the S1 nerve root? A) Medial aspect of foot B) Anterior thigh C) Lateral and plantar aspect of foot D) Dorsum of foot Answer: Lateral and plantar aspect of foot Explanation: The S1 nerve root provides sensory innervation to the lateral and plantar aspects of the foot. 5. A positive straight leg raise test typically indicates irritation of which nerve root? A) L2 B) L3 C) L4 D) L5 or S1 Answer: L5 or S1