Neuro Examination Flashcards
What are the signs typically found in an UMN lesion?
pyramidal weakness - arm extensors, leg flexors. loss of skilled fine finger movements. Spasticity. Increased tone that is velocity dependent and non-uniform. Hyperreflexia. Upgoing plantars (+ve babinski) +/- clonus +/- Hoffman’s reflex.
What are the signs typically found in an LMN lesion?
wasting +/- fasciculation. Hypotonia. Flaccidity. Hyporeflexia/absent reflexes. Downgoing plantars (flexor, Babinski -ve)
What is the grading system for muscle weakness and what is the definition for each grade?
MRC classification: Grado 5 = normal power. Grade 4 = active movement against resistance. Grade 3 = active movement against gravity. Grade 2 = some active movement with gravity eliminated. Grade 1 = flicker of contraction. Grade 0 = no muscle contraction
What are the nerve roots tested in abduction/adduction of the shoulder, extension/flexion of the elbow, wrist and fingers and abduction of the fingers?
shoulder abd: C5, shoulder add: C5-7. Elbow flex: C5-6 (Biceps), ext: C7 (Triceps). Wrist flex: C7-8, ext: C7. Finger flex: C8, ext: C7, (+thumb) abd: T1
What are the reflexes in the upper limb and what spinal root do they originate?
Biceps: C5/6, supinator: C4/6, triceps: C7
What are the nerve roots tested in adduction of the hip, extension and flexion of the hip and knee, dorsiflexion, plantarflexion and eversion of the ankle and big toe extension?
Hip flex: L1-2, add: L2-3, ext: L5-S1. Knee flex: L5-S1, ext: L3-L4. Ankle dorsi: L4, eversion: L5-S1, plantar: S1-S2. Big toe ext: L5
What are tests for the 3 main nerves of the hand/wrist?
radial = wrist extension against resistance. Median = make a fist around fingers and grip, thumb abduction, pincer grip with little finger. Ulnar = cross fingers, finger adduction
What are the main nerves of the lower limb? What do they supply?
femoral nerve = iliospoas (flex hip), quadriceps femoris (extend knee). Obturator nerve = hip adductors. Inferior gluteal nerve = gluteus maximus (hip extension). Superior gluteal nerve = gluteus medius and minimus (abduction and internal hip rotation with flexion at hip and knee). Common peroneal nerve = hamstrings, foot extensors, tibialis anterior and peroneus longus and brevis (knee flexion, dorsiflexion of ankle and toes, and foot eversion). Tibial nerve = tibialis posterior, gastrocnemius, toe flexors and small muscles of foot (invert foot, plantarflexion of ankle, toe flexion and produce arch).
What are the nerves of the brachial plexus and what do they supply?
Musculocutaneous = M: anterior compartment of arm (BBC - biceps brachii, brachialis, coracobrachialis), S: lateral aspect of FA. Axillary = M: teres minor and deltoid, S: Regimental badge. Median = M: pronators, wrist and digit flexion (LLOAF - 2 lat lumbricals, opponens pollicis, abductor pollics brevis, flexor pollicis brevis), S: palmar side of thumb and 2.5 fingers. Radial = M: triceps and FA extensors, S: posterior FA and dorsal thumb and 2.5 fingers. Ulnar = M: intrinsic muscles of hand (excl two lateral lumbricals and thenar muscles) and flexor carpi ulnaris and medial half of flexor digitorum profundus, S: medial 1.5 fingers and posterior medial FA.
What are the sites to test dermatomes and peripheral nerves in the upper limb?
radial = snuff box. Median = tip of middle finger. Ulnar = little finger. C5 = deltoid, C6 = lateral arm/thumb, C7 = middle finger, C8 = little finger
What are the sites to test dermatomes and peripheral nerves in the lower limb?
Obturator = inner thigh, femoral = medal anterior knee Common peroneal = lateral posterior calf, tibial = medial heel L2 = lateral thigh L3 = medial anterior knee, L4 = medial malleolus, L5 = big toe, S1 = outside foot, S2 = posterior knee
What sensation runs down the dorsal column tract?
fine touch, vibration, two-point discrimination and proprioception - decussate at level of medulla?
What sensation runs down the spinothalamic tract?
pain and temperature (and gross touch) - decussate just before exiting spinal cord
