NEURO EXAMINATION - Limbs Exam Flashcards
Essentials of Tendon Hammer
PATIENT RELAXED
LET HAMMER SWING, HOLD @ END
Locate tendon first, then look for muscular contractions as well as resulting distal movement
UPPER LIMB Order
ASSESSMENT
TONE
POWER
CO-ORDINTION
REFLEXES
SENSATION
UL OBSERVATION
?atrophy = denervation OR disuse
fasciculation = denervation
skeletal deformities
scars
tremor, dystonia
UL OBSERVATION
SWIFT
scars, wasting, involuntary, fasciculations, tremor
?atrophy = denervation OR disuse
tremor, dystonia
*pronator drift
Types of Hypertonia
SPASTICITICITY = increased tone on rapid movement
(suggestive of UMN)
RIGIDITIY = increased tone on slow movement
(suggestive of extrapyramidal movement disorder)
Types of Hypertonia
SPASTICITICITY = increased tone on rapid movement
(suggestive of UMN)
RIGIDITIY = increased tone on slow movement
(suggestive of extrapyramidal movement disorder)
UL POWER
shoulder abduction
elbow flex/ext
wrist flex/ext
finger flex/ext
intrinsic finger abduction = splayed out resist
thumb abduction =
squeeze finger
Assessment of Power
MRC Grading Scale
0 - no movement
5 - full movement
UL Coordinaton
- Postural tremor and dystonia,
- finger-nose test
- rapid alternating movements to check for Dysdiadochokinesia
* ipsilateral cerebellar pathology
UL REFLEX
BICEPS: biceps tendon
SUPINATOR: hitting few cm above distal head of radius
TRICEPS: strike triceps directly
*reinforcement = clench teeth
UL SENSATION
EXPLAIN EACH MINI TEST!
- cotton wool / pinprick
C5 (latral biceps), C6 (thumb), C7, C8, T1, T2 (medial/triceps)
- VIBRATION SENSE. Move proximally if cannot feel. Ensure bony process.
- PROPRIOCEPTION. Small finger movements.
start large n become smaller
LOWER LIMB OBSERVATION
muscle atrophy, fasciculations, peripheral oedema & vasc disease
SWIFT
LL TONE
passive movement, check for pain first, ensure relaxed
HIP ROTATION
HIP KNEE FLEXION
*lift knee up, should be relaxed
hypertonia = heel will elevate too
LL POWER
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
LL COORDINATION
heel shin test = progress faster
spasticity or weakness can make it more difficult
LL REFLEXES
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)
GRADING OF REFLEXES
0 - absent
*present only w/ re-inforcement
+ present but depressed
++ normal
+++ EXAGGERATED
*clonus = uncontrolled tremor-like movement
LL SENSATION
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
Gait
- PROXIMAL LL WEAKNESS: rise from chair without using arms
- DISTAL LL FUNCT: walk on heels/tiptoes
- Walk briskly: assess leg movements, and posture
* ?arm swing - Balance: walk heel-to-toe tightrope
- LL PROPRIOCEPTION = RHOMBERGS TEST
close eyes and stand still to see for
Lack of light touch sensation on lower limb means
dorsal column or spinothalamic tract abnormality
