NEURO EXAMINATION - Limbs Exam

Question 1

Essentials of Tendon Hammer

Answer 1

PATIENT RELAXED

LET HAMMER SWING, HOLD @ END

Locate tendon first, then look for muscular contractions as well as resulting distal movement

Question 2

UPPER LIMB Order

Answer 2

ASSESSMENT

TONE

POWER

CO-ORDINTION

REFLEXES

SENSATION

Question 3

UL OBSERVATION

Answer 3

?atrophy = denervation OR disuse

fasciculation = denervation

skeletal deformities

scars

tremor, dystonia

Question 4

UL OBSERVATION

Answer 4

SWIFT
scars, wasting, involuntary, fasciculations, tremor

?atrophy = denervation OR disuse

tremor, dystonia

*pronator drift

Question 5

Types of Hypertonia

Answer 5

SPASTICITICITY = increased tone on rapid movement
(suggestive of UMN)

RIGIDITIY = increased tone on slow movement
(suggestive of extrapyramidal movement disorder)

Question 6

Types of Hypertonia

Answer 6

SPASTICITICITY = increased tone on rapid movement
(suggestive of UMN)

RIGIDITIY = increased tone on slow movement
(suggestive of extrapyramidal movement disorder)

Question 7

UL POWER

Answer 7

shoulder abduction

elbow flex/ext

wrist flex/ext

finger flex/ext

intrinsic finger abduction = splayed out resist
thumb abduction =

squeeze finger

Question 8

Assessment of Power

Answer 8

MRC Grading Scale

0 - no movement
5 - full movement

Question 9

UL Coordinaton

Answer 9

1. Postural tremor and dystonia,
2. finger-nose test
3. rapid alternating movements to check for Dysdiadochokinesia
   * ipsilateral cerebellar pathology

Question 10

UL REFLEX

Answer 10

BICEPS: biceps tendon

SUPINATOR: hitting few cm above distal head of radius

TRICEPS: strike triceps directly

*reinforcement = clench teeth

Question 11

UL SENSATION

Answer 11

EXPLAIN EACH MINI TEST!

1. cotton wool / pinprick

C5 (latral biceps), C6 (thumb), C7, C8, T1, T2 (medial/triceps)

2. VIBRATION SENSE. Move proximally if cannot feel. Ensure bony process.
3. PROPRIOCEPTION. Small finger movements.
   start large n become smaller

Question 12

LOWER LIMB OBSERVATION

Answer 12

muscle atrophy, fasciculations, peripheral oedema & vasc disease

SWIFT

Question 13

LL TONE

Answer 13

passive movement, check for pain first, ensure relaxed

HIP ROTATION

HIP KNEE FLEXION

*lift knee up, should be relaxed

hypertonia = heel will elevate too

Question 14

LL POWER

Answer 14

grade by MRC scale and compare

hip flex/ext

knee flex/ext: bend knee, pull heel toward bottom and straighten

anke dorsiflex/plantarflex

ankle inversion/eversion

Question 15

LL COORDINATION

Answer 15

heel shin test = progress faster

spasticity or weakness can make it more difficult

Question 16

LL REFLEXES

Answer 16

KNEE REFLEX = support knee , strike patellar ligament

ANKLE REFLEX = clear viewing of calf muscle, strike achilles tendon

alternatively BRISK AANKLE REFLEX = hit sole via finger strike; NOT AS SENSITIVE

*reinforcement, squeeze hands

ANKLE CLONUS = sudden dorsiflexion
abn = sustained clonus

PLANTAR RESPONSE = stroke lateral sole move medially
normal = big toe flexion
abn = extensor (babinski)

Question 17

GRADING OF REFLEXES

Answer 17

0 - absent

*present only w/ re-inforcement

+ present but depressed

++ normal

+++ EXAGGERATED

*clonus = uncontrolled tremor-like movement

Question 18

LL SENSATION

Answer 18

cotton/pinprick, COMPARE BOTH SIDES!

L1 - top medial thigh (speedos)

L2 - lateral anterior thigh

L3 - medial aspect of knee

L4 - medial lower leg and ankle

L5 - dorsum big toe and medial aspect

S1 - lateral aspect of foot (pinky toe)

• VIBRATION - distally, move proximally, bony landmark
• PROPRIOCEPTION - large to small toe movements

Question 19

Gait

Answer 19

1. PROXIMAL LL WEAKNESS: rise from chair without using arms
2. DISTAL LL FUNCT: walk on heels/tiptoes
3. Walk briskly: assess leg movements, and posture
   * ?arm swing
4. Balance: walk heel-to-toe tightrope
5. LL PROPRIOCEPTION = RHOMBERGS TEST
   close eyes and stand still to see for

Question 20

Lack of light touch sensation on lower limb means

Answer 20

dorsal column or spinothalamic tract abnormality