I overlooked this when taking the test the first time. Besides your explanation, I want to make sure I am naming correctly, is the reason #64 can be considered l4-L5 because the Hamstring is grade 3 or better?
Going from the Campbell’s text, for naming myelomeningocele; table 23.1 pg 552
L1-L2 Exceeds criteria for L1 but does not meet L2 criteria.a
L2 Iliopsoas, sartorius, and the hip adductors all must be grade 3 or better.
L3 Meets or exceeds the criteria for L2 plus the quadriceps are grade 3 or better.
L3-L4 Exceeds criteria for L3 but does not meet L4 criteria.
L4 Meets or exceeds the criteria for L3 and the medial hamstrings or the tibialis anterior is grade 3 or better.
A weak peroneus tertius may also be seen.
– Exceeds criteria for L4 but does not meet L5 criteria.
L5 Meets or exceeds the criteria for L4 and has lateral hamstring strength of grade 3 or better plus one of the following: gluteus medius grade 2 or better, peroneus tertius grade 4 or better, or tibialis posterior grade 3 or better.
For an L4, possible muscle function includes: medial knee flexors (3/5) and ankle dorsiflexors (3/5) as well as all levels from L3 (knee extensors 3/5) and L2 (hip adductors 3/5, hip flexors 3/5), L1 (lower trunk, hip flexors 2/5), and above. For an L5 lesion, possible muscle function includes: hip abductors (2/5), lateral knee flexors (3/5), ankle invertors (3/5), toe extensors (palpable at ankle). L5 clues in this patient are the hip abductors, foot inversion, and toe extension. We would expect stronger muscle groups if the child was S1-3 as well as hip extension and ankle plantarflexion present to some extent.