Key sensory points:
- C2 At least one cm lateral to the occipital protuberance at the base of the skull. Alternately, it can be located at least 3 cm behind the ear.
- C3 In the supraclavicular fossa, at the midclavicular line.
- C4 Over the acromioclavicular joint.
- C5 On the lateral (radial) side of the antecubital fossa just proximal to the elbow (see image below).
- C6 On the dorsal surface of the proximal phalanx of the thumb.
- C7 On the dorsal surface of the proximal phalanx of the middle finger.
- C8 On the dorsal surface of the proximal phalanx of the little finger.
- T1 On the medial (ulnar) side of the antecubital fossa, just proximal to the medial epicondyle of the humerus.
- T2 At the apex of the axilla. T2 T1 C5 International Standards for the Classification of Spinal Cord Injury Key Sensory Points June 2008
- T3 At the midclavicular line and the third intercostal space, found by palpating the anterior chest to locate the third rib and the corresponding third intercostal space below it.
- T4 At the midclavicular line and the fourth intercostal space, located at the level of the nipples.
- T5 At the midclavicular line and the fifth intercostal space, located midway between the level of the nipples and the level of the xiphisternum.
- T6 At the midclavicular line, located at the level of the xiphisternum.
- T7 At the midclavicular line, one quarter the distance between the level of the xiphisternum and the level of the umbilicus.
- T8 At the midclavicular line, one half the distance between the level of the xiphisternum and the level of the umbilicus.
- T9 At the midclavicular line, three quarters of the distance between the level of the xiphisternum and the level of the umbilicus.
- T10 At the midclavicular line, located at the level of the umbilicus.
- T11 At the midclavicular line, midway between the level of the umbilicus and the inguinal ligament.
- T12 At the midclavicular line, over the midpoint of the inguinal ligament.
- L1 Midway between the key sensory points for T12 and L2.
- L2 On the anterior-medial thigh, at the midpoint drawn on an imaginary line connecting the midpoint of the inguinal ligament and the medial femoral condyle.
- L3 At the medial femoral condyle above the knee.
- L4 Over the medial malleolus.
- L5 On the dorsum of the foot at the third metatarsal phalangeal joint.
- T12 L1 L2 L3 L4 L5 International Standards for the Classification of Spinal Cord Injury Key Sensory Points June 2008
- S1 On the lateral aspect of the calcaneus.
- S2 At the midpoint of the popliteal fossa.
- S3 Over the ischial tuberosity or infragluteal fold (depending on the patient their skin can move up, down or laterally over the ischii).
- S4/5 In the perianal area, less than one cm. lateral to the mucocutaneous junction.
ASIA WORKSHEET <pdf>
“ASIA Learning Center”. Asia-spinalinjury.org. N.p., 2017. Web. 23 Mar. 2017.
Asia impairment scale (modified from Frankel)
- A=Complete. No sensory or motor function is preserved in the sacral segments S4-S5
- B=Incomplete. Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5.
- C=Incomplete. Motor function is preserved below the neurological level, and more than half of key muscles below the neurological level have a muscle grade less than 3.
- D=Incomplete. Motor function is preserved below the neurological level, and at least half of key muscles below the neurological level have a muscle grade greater than or equal to 3.
- E=Normal. Sensory and motor function is normal.
Key Sensory Points in SCI evaluation:
- 0 = absent
- 1 = impaired (partial or altered appreciation, including hyperaesthesia)
- 2 = normal
- NT = not testable
The testing for pin sensation is usually performed with a disposable safety pin; light touch is tested with cotton. In testing for pin appreciation, the inability to distinguish between dull and sharp sensation is graded as 0
- C2=Occipital protuberance
- C3=Supraclavicular fossa
- C4=Top of the acromioclavicular joint
- C5=Lateral side of the antecubital fossa
- C7=Middle finger
- C8=Little finger
- T1=Medial (ulnar) side of the antecubital fossa
- T2=Apex of the axilla
- T3=Third intercostal space (IS)*
- T4=Fourth IS (nipple line)*
- T5=Fifth IS (midway between T4 and T6)*
- T6=Sixth IS (level of xiphisternum)*
- T7=Seventh IS (midway between T6 and T8)*
- T8=Eighth IS (midway between T6 and T10)*
- T9=Ninth IS (midway between T8 and T10)*
- T10=Tenth IS (umbilicus)*
- T11=Eleventh IS (Midway between T10 and T12)*
- T12=Inguinal ligament at mid-point
- L1=Half the distance between T12 and L2
- L2=Mid-anterior thigh
- L3=Medial femoral condyle
- L4=Medial malleolus
- L5=Dorsum of the foot at the third metatarsal phalangeal joint
- S1=Lateral heel
- S2=Popliteal fossa in the mid-line
- S3=Ischial tuberosity
- S4-5 = Perianal area (taken as one level)
*Asterisks indicate that the point is at the mid-clavicular line
Motor Points in SCI Evaluation:
- C5 = Elbow flexors (biceps, brachialis)
- C6 = Wrist extensors (extensor carpi radialis longus and brevis)
- C7 = Elbow extensors (triceps)
- C8 = Finger flexors (flexor digitorum profundus) to the middle finger
- T1 = Small finger abductors (abductor digiti minimi)
- L2 = Hip flexors (iliopsoas)
- L3 = Knee extensors (quadriceps)
- L4 = Ankle dorsiflexors (tibialis anterior)
- L5 = Long toe extensors (extensor hallucis longus)
- S1 = Ankle plantarflexors (gastrocnemius, soleus)
Jr, Frederick M Maynard et al. “International Standards For Neurological And Functional Classification Of Spinal Cord Injury”. Spinal Cord 35.5 (1997): 266-274. [pdf]
Scientific American. January 2016. Traumatic Brain and Spinal Cord Injuries – Neurology. Mohit Datta, MD, Geoffrey S.F. Ling, MD, PhD, FAAN. Uniformed Services University of the Health Sciences, Bethesda, MD