what does the grade of joint movement of S1/T1/L2 indicate?

Neurologic level of
injury

The NLOI is defined as the most
caudal (ie, lowest) level of the href="http://www.medscape.com/viewarticle/567856">spinal cord that has
normal motor and sensory function. The motor level, which is a better predictor of the
patient's functional abilities, is determined by the manual testing of key muscle groups
on both sides of the body. These groups represent neurologic levels, and findings are
graded 0-5, as follows:

• Grade 5 - Normal; muscle
  movement through the complete range of motion (ROM) against gravity and full resistance
  


• Grade 4 - Good; muscle movement through the complete ROM
  against gravity and moderate resistance


• Grade 3 - Fair;
  muscle movement through the full ROM against gravity alone
  


• Grade 2 - Poor; muscle movement through the full ROM
  with gravity eliminated


• Grade 1 (Trace) - Palpable
  muscle contraction or joint movement, but not through complete ROM, even with gravity
  eliminated


• Grade 0 - Zero; no muscle movement or
  palpable
  contraction

Motor levels
representing upper and lower extremity function (and key muscles) are as
follows:

• C5 - Elbow flexion (biceps)
  


• C6 - Wrist extension (extensor carpi radialis)
  


• C7 - Elbow extension (triceps)
  


• C8 - Finger flexion (flexor digitorum profundus)
  


• T1 - Small finger abductors (abductor digiti minimi)
  


• L2 - Hip flexion (iliopsoas)
  


• L3 - Knee extension (quadriceps)
  


• L4 - Ankle dorsiflexion (tibialis anterior)
  


• L5 - Great toe extension (extensor hallucis longus)
  


• S1 - Ankle plantar flexion (gastrocsoleus
  complex)

Sensory function is determined by
examining 28 key sensory points on both sides of the body. These points are designated
within dermatomes for light touch and pin prick. They are graded as follows: 2 = normal,
1 = impaired, and 0 = absent.

Sensory levels are designated
as follows:

• C2 - Occipital protuberance
  


• C3 - Supraclavicular fossa
  


• C4 - Top of acromioclavicular joint
  


• C5 - Lateral antecubital fossa
  


• C6 - Thumb


• C7 - Middle
  finger


• C8 - Little finger
  


• T1 - Medial antecubital fossa
  


• T2 - Apex of axilla


• T3
  - Third intercostal space (IS)


• T4 - Fourth IS (nipple
  line)


• T5 - Fifth IS (midway T4-T6)
  


• T6 - Sixth IS (xiphisternum)
  


• T7 - Seventh IS (midway T6-T8)
  


• T8 -  Eighth IS (midway T6-T10)
  


• T9 - Ninth IS (midway T8-T10)
  


• T10 - Tenth IS (umbilicus)
  


• T11 - 11th IS (midway T10-T12)
  


• T12 - Inguinal ligament (midpoint)
  


• L1 - Half the distance T12-L2
  


• L2 - Midanterior thigh
  


• L3 - Medial femoral condyle
  


• L4 - Medial malleolus


• L5
  - Dorsum of foot (3rd metatarsophalangeal joint)


• S1
  - Lateral heel


• S2 - Popliteal fossa (midline)
  


• S3 - Ischial tuberosity
  


• S4-5 - Peri-anal
  area

ASIA Impairment
Scale

The ASIA Impairment Scale classifies
the completeness of SCI on a scale from A-E, as
follows2,3,4,5
:

• A - Complete; no sacral motor or sensory
  sensation in segments S4-5


• B - Sensory incomplete;
  preservation of sensation below the level of injury, extending through sacral segments
  S4-5


• C - Motor incomplete; voluntary anal sphincter
  contraction or sensory sacral sparing with sparing of motor function distal to 3 levels
  below the motor level of injury, with the majority of key muscles having a strength
  grade of less than 3


• D - Motor incomplete; voluntary
  anal sphincter contraction or sensory sacral sparing with sparing of motor function
  distal to 3 levels below the motor level of injury, with the majority of key muscles
  having a strength grade of 3 or greater


• E - Normal;
  normal motor and sensory recovery (hyperreflexia may be
  present)