Myotomes, Somatic Reflexes & Dermatomes

Question 1

SWIFT in upper neurological exam

Answer 1

scars
wasting of muscles
involuntary movements
fasciculations
tremor

Question 2

stages of an upper limb neurological exam

Answer 2

general inspection using swift
tone of upper limbs
power of upper limbs
biceps, triceps and supinator reflexes
sensation with light touch and pin prick
vibrating sensation with tuning fork
proprioception
finger to nose test
assess for dysdiadochokinesia
summary of the findings for the exam

Question 3

general inspection using SWIFT upper limb neurological examination

Answer 3

ask patient to hold arms out straight and spread fingers
then ask them to turn arms over
close eyes
ask them to hold arms infront still
then ask them to turn them back over
then ask to open their eyes

Question 4

testing muscle tone upper limb neurological examination

Answer 4

ask patient to let arms go floppy
chicken wings
bicep curls
inward and outward flap motion of hand
motion of opening door with a screw doorknob
repeat on the other side

Question 5

testing the power of upper limb neurological examination

Answer 5

isolate by putting one hand on cap of the shoulder then
shoulder abduction, “don’t let me push them down” and repeat both sides
shoulder adduction “don’t let me push them up” and repeat both sides
isolate by putting one hand under the elbow
elbow flexion “stop me from pulling them down” and repeat both sides
elbow extension “stop me from pushing them up” and repeat both sides
ask to put arms out straight and cock wrists back
isolate by putting one hand on wrist
wrist extension “stop me from straightening”, do this motion by putting base of my fist onto their surface of hand, repeat both sides
ask them to put wrists down
isolate by putting one hand on wrist
wrist flexion “stop me from pushing them up”
do this motion by putting palm of my hand across their clenched knuckles, repeat both sides
ask patient to put hands straight out infront of them and fingers together, isolate wrist
finger extension: put two fingers ontop of patients fingers and ask them to “ stop me from pushing them down” nd repeat both sides
isolate by holding knuckles and ask patient to push index finger out and stop me from pushing it in and repeat both sides
then ask them to put little finger out and stop me from pushing it in
turn hands over, isolate at wrists and ask them to put thumbs up and tell them to stop you from pushing it down and then repeat

Question 6

what do you test when testing the power of upper limbs

Answer 6

shoulder abduction
shoulder adduction
elbow flexion
elbow extension
wrist extension
wrist flexion
finger extension
finger flexion
stop index finger pushing out
stop little finger pushing out
stop thumb pushing down

Question 7

reflexes tested upper limb neurological examination

Answer 7

Question 8

testing sensation with light touch and pin prick upper limb neurological examination

Answer 8

place cotton wool on supraclavicular notch and ask if patient can feel it
ask patient to close their eyes
tap left to right and ask patient if they could say yes when they feel the touch
tap top part of shoulder for c3,4
tap midway between shoulder and elbow for c5
tap thumb for c6
tap middle finger for c7
tap little finger for C8
then tap close to armpit for T1
ask if felt the same on both sides

then repeat using pin
tell them which end is sharp or blunt and ask them to tell you when you tap on the same areas as above which is sharp and which is blunt

Question 9

testing vibration sensation upper limb neurological examination

Answer 9

place tuning fork on suprasternal notch and ask if they can feel
ask patient to close their eyes
then place on thumb knuckle vibrate and ask them if they can feel it and to say when it stops
manually stop vibration
repeat on other hand
if no sensation then move to more proximal bony point

Question 10

proprioception upper limb neurological examination

Answer 10

show them with their thumb what up and down feels like
then ask them to close their eyes and tell me what up and down is
isolate just under thumb knuckle
repeat on other hand

Question 11

finger to nose test upper limb neurological examination

Answer 11

ask them to touch their nose
hold my hand infront of them
ask them to touch my finger with theirs
then to touch their nose again
and back and forth
then repeat on other side
looking for tremors or difficulty

Question 12

assessing for dysdiadokinesia upper limb neurological examination

Answer 12

ask them to place one hand on top of the other so thumbs would be aligned
ask them to flip up and down as fast as they can
repeat other side with the alternating hand on the top

Question 13

summary upper limb neurological examination

Answer 13

sum up for each stages
then say that to complete your examination you would complete a full cranial nerve examination, lower limb examination and a gait examination

Question 14

stages of lower limb neurological examination (year 1)

Answer 14

general inspection
tone
ankle clonus
power of lower limbs
reflexes
sensation with soft touch and pin prick
vibration test with tuning fork
proprioception
coordination, heel to shin test
summary of findings and further examinations

Question 15

General inspection lower limb examination

Answer 15

SWIFT
Also check for any items around the bed such as a walking stick

Question 16

Tone of muscles in lower limb neurological examination

Answer 16

Ask patient to let their legs go floppy
Hold leg at knee and jiggle back and forth repeat both sides
Lift leg and knee and drop repeat both sides

Question 17

Ankle clonus in lower limb neurological examination

Answer 17

Lift leg up so knee bends
Hold hands width above ankle
Ask patient to let foot go floppy
Wriggle foot
Then sharply push up on bottom of foot
Repeat both sides

Question 18

Power in lower limb neurological examination

Answer 18

Hip flexion, ask patient to lift leg up. Restrict movement at hip and put hand on thigh and ask them to stop me from pushing leg down repeat both sides
Hip extension, hand under thigh and and hand on hip to isolate. Ask them to stop from lifting up
Put hands between thighs ask them to push legs together, hip adduction
Put hands either side of thighs, ask them to push legs apart hip abduction
Bend knee up and have one hand in knee pit other on back of ankle and ask to bring ankle towards them. Knee flexion. Repeat both sides
Hands in same position but restricting on top of shin and ask patient to kick against me. Repeat both sides knee extension
Isolate at ankle and hand horizontally across toes. Ask them to restrict me from pushing down. Ankle dorsi flexion and repeat both sides
Isolate at ankle and ask them to push down onto hand. Repeat both sides for ankle plantar flexion
Isolate at ankle and ask them to bring big toe towards them and stop me from pushing it down repeat both sides
Isolate at ankle Ask patient to push foot in towards my hand and stop me from pushing it out and repeat
Isolate at ankle and ask patient to push foot outwards towards my hand and repeat

Question 19

Reflexes in lower limb neurological examination

Answer 19

Question 20

Light touch and Pin prick sensation testing

Answer 20

Place cotton wool at suprasternal notch
Ask if they can feel
Then ask to close their eyes
Ask them to say yes when they feel it and after each new place test same on other side
Tap top of thigh for L2
Tap knee cap for L3
Tap big toe for L4
Tap middle toe for L5
Tap little toe for S1
Ask if it felt same on both sides
Do the same but show them sharp and blunt and ask them to tell you if it is sharp or blunt

Question 21

Testing for vibration in lower limb neurological examination

Answer 21

Show patient feeling of tuning fork by placing it on supraclavicular notch
Ask them to tell you when you feel it and when it stops
Ask to close their eyes
Place on first knuckle of big toe
Let it vibrate and manually stop
Repeat other side
If they don’t feel go to next most prominent bony point

Question 22

Proprioception lower limb neurological exam

Answer 22

Isolate at the knuckles on toes
Show what up feels like
Show what down feels like
Ask to close eyes and tell you if it’s up or down
Repeat both sides

Question 23

Coordination testing lower limb neurological exam

Answer 23

Ask patient to lift one knee up and rest on shin of other leg
Ask them to rub foot down to heel up in the air and back down to touch shin as quick as they can
Repeat other side
Ask them to tap both feet against your hands at same time

Question 24

Summary lower limb exam

Answer 24

State findings
Say you would do a gait assessment, cranial nerve exam and upper limb exam