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must fail before weakness is clinically detectable Finally, reinnervation may restore strength in muscles that were previously weak This is particularly true in the more proximally located muscles innervated by the involved segment The evaluation of muscle weakness in the lower extremity differs in comparison to the upper limb The lower extremity has fewer testable muscles and actions than the upper extremity For example, there is no pronation or supination at the knee, and the intrinsic foot muscles cannot be tested with the same bedside precision as the intrinsic hand muscles There is also signi cant overlap that may occur between nerve and segmental innervation For example, it may be clinically dif cult to distinguish between a femoral neuropathy and an L3 4 radiculopathy, as the primary function of both is to ex the hip and extend the knee What is advantageous, however, particularly from an electrodiagnostic perspective, is that many myotomes are represented both proximally and distally in the lower extremity For example, both foot dorsi exion and hip abduction have strong L5 innervation in most individuals In contrast, in the upper extremity, all muscles belonging to the same segment tend to cluster at different levels of the upper extremity, eg, C5 around the shoulder and C8 T1 in the hand Paresthesias (ie, positive sensory symptoms) and, to a lesser extent, numbness (ie, negative sensory symptoms or sensory loss) are commonplace in monoradiculopathies As emphasized in 1, it is important to recognize that the occurrence of paresthesias without demonstrable sensory loss is a common clinical event It is equally important to realize the clinical signi cance of dermatomal overlap The topographical distribution of paresthesias described by the patient and sensory loss that may be demonstrated is far smaller than predicted, based on commonly published dermatomal maps (Fig 22 10) Paresthesias and sensory loss resulting from a monoradiculopathy commonly persist long after radicular pain and weakness have resolved.

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Muscle Action Most Commonly Weak Hip exion Knee extension (one leg partial squat) Knee extension (one leg partial squat) Great toe dorsi exion

while ( (c = fgetc( fp )) != EOF ) putchar( c ); putchar() prints the specified character to the console window. We could have accom-

Other Muscle Actions That May Be Weak NA Hip exion and adduction Hip exion and adduction Dorsi exion of digits II V and foot, ankle inversion and eversion, knee exion, and hip abduction Toe and knee exion and hip extension

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The max and min parameters will not have a value until you run this function, which you will do in a few more steps Also, variables created within a function can only be used in that function, and nowhere else in your code Why would you want to do that For one thing, the range variable will only be used in this function For another, the value of the range variable is dependent on the values passed in via the min and max parameters

Characteristic Areas of Sensory Symptoms/Sensory Loss Anterior thigh Medial knee Medial leg Great toe, dorsum of foot, and distal-lateral leg

plished the same thing by using printf():

Ankle plantar exion (one leg rise on ball of foot)

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Suppression of muscle stretch re exes is a common although not invariable component of a monoradiculopathies In most instances, only the C6, C7, L3 4, and S1 segments are available for re ex testing If internal hamstring re exes are present, asymmetry may aid in the detection of an L5 radiculopathy This occurs infrequently enough to be of limited bene t Straight leg raising is a time-honored means by which to reproduce radicular pain in compressive monoradiculopathies due to disk herniations It is of little or no value in spondylytic disease A positive sign is nonlocalizing and may occur in disorders affecting the more distal nerve elements of the sacral plexus or sciatic nerve It is important to distinguish the reproduction of radicular pain from the discomfort of hamstring stretching Pain occurring at <70 is felt to be abnormal and to occur in 90% of patients with disk herniation12 Straight leg raising of the contralateral, nonsymptomatic limb that reproduces radicular pain in the symptomatic limb is felt to be a less sensitive and more speci c test In upper lumbar disk disease, pain may be reproduced by reverse straight raising, ie, by passively extending rather than exing the thigh at the hip joint13 A history of radicular pain (not back pain)

Number data type This variable will represent the random number generated when this function runs The value will be Mathrandom() * range + min

produced by increased intrathoracic pressure, eg, the Valsalva maneuver or cough, is a very speci c but insensitive indicator of lumbosacral root compression Although classic presentations include sciatica or radicular pain accompanied by segmental motor, sensory, and re ex ndings, it is important to recognize that variations on this theme do occur Patients may have either dermatomal sensory symptoms or myotomal motor signs in the absence or relative absence of pain On occasion, patients will have radicular pain with paresthesia that will abruptly resolve, only to be replaced by weakness in a segmental pattern It has been hypothesized that this may occur as a result of disk sequestration and migration14 The authors personal observations of this syndrome occurring in the immediate aftermath of spinal manipulation would support this contention

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