Anatomic Basis of Clinical Testing Pt. 2 (9/5c) Flashcards
Reflex
Tests the afferent (spinal cord) and efferent (muscle) areas
CNS/PNS Neurons
CNS = upper motor neurons
PNS = lower motor neurons
Reflex - CNS Role
should normally put a slight inhibition on the reflex so the motion isn’t exaggerated
Reflex - PNS Role
innervates muscle by relaying sensation to the motor neuron
if not operating correctly, there would be reduced response
Pattern recognition - Dermatomes
peripheral nerve sensory distribution
Pattern recognition - Myotomes
peripheral nerve muscle innervations
Clinical testing of myotomes - Weakness
Looking for
1) weakness in muscles predominantly innervated by specific spinal nerves
2) pattern of weakness representative of a specific spinal nerve
Myotomes Chart - Shoulder Shrug
C2 , C3, C4
Myotomes Chart - Shoulder abduction
C5
Myotomes Chart - Elbow flexion
C6
Myotomes Chart - Wrist extension
C6
Myotomes Chart - Elbow extension
C7
Myotomes Chart - Thumb extension
C8
Myotomes Chart - Finger abduction
T1
Myotomes Chart - Hip flexion
L1 , L2
Myotomes Chart - Knee extension
L3 , L4
Myotomes Chart - Dorsiflexion
L4 , L5
Myotomes Chart - Great toe extension
L5
Myotomes Chart - Plantarflexion
S1
Muscle Impairment - Reasons
Peripheral nerve involvement → Spinal, Peripheral
CNS function → Motor control, Central inhibition
Disuse
Injury/mechanical stresses
Disease
Ischemia
Central inhibition
active nervous process arising in the CNS and leading to the suppression/prevention of excitation
Muscle Impairment - Clinical Signs
Weakness
Decreased control
Muscle atrophy
Pain/tenderness/cramping
Muscle Impairment - Clinical Assessment
Sensory Testing
Muscle Testing
Sensory testing (muscle impairment)
Looking for:
dermatomal distribution of symptoms
peripheral nerve cutaneous distribution of symptoms
other patterns (like stroke)
Muscle testing (muscle impairment)
Looking for:
myotomal pattern of weakness
weakness associated with a peripheral nerve
weakness NOT representative of a neurologic pattern
Symptoms of peripheral circulatory impairment
Changes in skin color quality
Pain (ischemic/general)
Swelling
Absent or decreased pulse
Digestive system
Alimentary canal/nutrition
Referred pain → often experience pain in other seemingly unrelated areas
(EX: pain down the arm, pain around scapula, etc)
2 Point Discrimination
the ability to discern that two nearby objects touching the skin are truly two distinct points, not one
usually used with a sharp item during a neuro exam
Barognosis
ability to evaluate the weight of objects by holding/lifting them
