Examination

Question 1

What is the main question to ask in a peripheral nerve exam?

Answer 1

The main question is to ask if the upper motor neurone or lower motor neurone

Question 2

What can you see on General inspection for UMN and LMN lesions?

Answer 2

UMN- no fasciculation or significant wasting (there may be some disuse atrophy or contractures)

LMN- wasting and fasciculation of muscles

Question 3

In what type of lesion would pronator drift be present?

Answer 3

Upper motor neurone lesion

Question 4

What would happen to tone in
A) UMN
B) LMN

Lesion?

Answer 4

UMN- increased spasticity or rigidity

LMN- decreased (hypotonia) or normal

Question 5

How would power differ in a UMN/LMN lesion?

Answer 5

UMN- classically a pyramidal pattern of weakness (extensors weaker than flexors in the arms, vice versa in the legs)

LMN- different patterns of weakness depending on the cause (distal in peripheral neuropathy, proximal weakness in muscle disease)

Question 6

What happens with reflexes in UMN/LMN lesion?

Answer 6

UMN- exaggerated or brisk (hyperreflexia)

LMN- reduced or absent (hyporeflexia or areflexia)

Question 7

What would wasting of muscles indicate?

Answer 7

suggestive of lower motor neuron lesions or disuse atrophy.