Neurological System Flashcards
What does spasticity indicate?
extrapyramidal tract lesions
What can cause hypertonia?
loss of the inhibition of the lower motor neurones by the upper motor lesions
What does rigidity indicate?
extrapyramidal tract lesions
What can cause hypotonia?
lower motor neurones
What muscles are responsible for shoulder abduction?
deltoid
What muscles are responsible for shoulder adduction?
- teres major
- latissimus dorsi
- pectoralis major
What myotomes are involved in shoulder abduction?
C5
What myotomes are involved in shoulder adduction?
C6/C7
What muscles are involved in the extension of the elbow joint?
triceps brachii
What muscles are involved in the flexion of the elbow joint?
biceps brachii
What myotomes are involved in elbow extension?
C7
What myotomes are involved in elbow flexion?
C5/C6
What muscles are involved in wrist flexion?
C6/C7
How do you test the abduction of the shoulder?
- flex elbows outwards
- apply downwards resistance
How do you test the adduction of the shoulder?
- flex elbows inwards
- apply upwards resistance
What would score a 0/5 MRC Muscle Power Scale?
No movement
What would score a 1/5 MRC Muscle Power Scale?
- barest flicker of movement
- not enough to move the structure
What would score a 2/5 MRC Muscle Power Scale?
voluntary movement which is not sufficient to overcome the force of gravity
What would score a 3/5 MRC Muscle Power Scale?
- Voluntary movement
- able to overcome gravity
- not able to overcome applied resistance
What would score a 4/5 MRC Muscle Power Scale?
- Voluntary movement
- able to over come resistance
What would score a 5/5 MRC Muscle Power Scale?
Normal strength
What do you need to do in order to accurately measure the power?
isolate and stabilise the joint
How do you assess the power of the musculature?
resist the movement by applying an opposite force and estimate the power of the contracting muscles
What nerve roots are responsible for the biceps reflex?
- C5
- C6
Where can you test for the biceps reflex?
the medial aspect of the antecubital fossa
What nerve roots are responsible for the triceps reflex?
- C7
- C8
Where can you test for the triceps reflex?
superior to the olecranon process of the ulna
What nerve roots are responsible for the supinator reflex?
- C5
- C6
Where can you test for the supinator reflex?
bracioradialis tendon (posterolateral aspect of the wrist)
What does areflexia suggest?
a lower motor neurone lesion
What does hyperreflexia suggest?
an upper motor neurone lesion
Where is the C5 dermatome?
lateral aspect of the lower edge of the deltoid muscle
Where is the C6 dermatome?
the palmar side of the thumb
Where is the C7 dermatome?
the palmar side of the middle finger
Where is the C8 dermatome?
the palmar side of the little finger
Where is the T1 dermatome?
The medial aspect of the antecubital fossa proximal to the medial epicondyle
Where is the T2 dermatome?
axilla
How do you assess tone in the lower limb?
- leg roll
- leg lift
- ankle clonus
What should you do when testing for ankle clonus?
quickly dorsiflex and partially evert the foot
What would suggest an abnormal ankle clonus?
more than 5 is abnormal
What muscles are responsible for the flexion of the hip joint?
- Psoas Major Iliacus - Sartorius - Rectus Femoris - Pectineus
What nerve is responsible for the flexion of the hip joint?
femoral nerve
What muscles are responsible for the extension of the hip joint?
Gluteus maximus
What nerve is responsible for the extension of the hip joint?
inferior gluteal nerve
What muscles are responsible for the abduction of the hip joint?
- Gluteus medius
- Gluteus minimus
What nerve is responsible for the abduction of the hip joint?
superior gluteal nerve
What muscles are responsible for the adduction of the hip joint?
- Adductor longus
- Adductor brevis
Adductor magnus - Pectineus
- Gracilis
What nerve is responsible for the adduction of the hip joint?
obturator nerve
What muscles are involved in the circumduction of the hip?
- Psoas Major
- Sartorius
- Rectus femoris
- Pectineus
- Gluteus maximus
- Gluteus medius
- Gluteus minimus
- Adductor longus
- Adductor brevis
- Gracilis
What muscles are involved in the internal rotation of the hip?
Obturator externus all: - adductors - semitendinosus - semimembranosus
What muscles are involved in the external rotation of the hip?
- `Piriformis
- Obturator internus
- Gemellus superior
- Gemellus inferior
- Quadratus femoris
What muscles are involved in the flexion of the knee?
- Biceps femoris
- Semitendinosis
- Semimembranosis
- Gracilis
What muscles are involved in the extension of the knee?
- Quadriceps femoris
What happens in a Trendelenburg test?
- place hands on the patients iliac crest
- ask patient to lift each foot in turn off the floor
During a Trendelenburg test, what is being tested with the right foot is lifted?
the left hip abductors
What will be seen during a Trendelenburg test if there is weakness in the abductors?
pelvis will sag away from the weak abductor
What nerve allows for knee extension?
femoral nerve
What nerve allows for knee flexion?
sciatic nerve
What muscles are involved in ankle dorsiflexion?
- Tibialis anterior
- Extensor hallucis longus
- Extensor digitorum longus
What innervates ankle dorsiflexion?
deep fibular nerve
What innervation is involved in ankle plantarflexion?
tibial nerve (S1-S2)
where does inversion take place?
subtalar joint
How do you assess for inversion of the ankle joint?
place hand laterally and ask patient to push against the resistance
How do you assess for eversion of the ankle joint?
place hand medially and ask patient to push against the resistance
What are the nerve roots responsible for the knee-jerk reflex?
- L2
- L3
- L4
What is the Jendrassik manoeuvre?
- clenching teeth
- flexing fingers in a hook-like form
What are the nerve roots responsible for the ankle-jerk reflex?
- S1
- S2
What is the impact of a femoral nerve lesion on motor control?
Quadriceps Paralysis
- weakness of the knee
- difficulty climbing up and down stairs
What is the impact of a femoral nerve lesion on sensory control?
loss of sensation in:
- the anterior and medial thigh
- medial side of leg
- medial border of the foot
- saphenous nerve is affected
What is the impact of a obturator nerve lesion on motor control?
Paralysis of all adductors
- difficulty crossing legs
What is the impact of a femoral nerve lesion on sensory control?
Pain on the medial thigh caused by: - pelvic disease - ovarian tumours (medial cutaneous nerve of the thigh)
What is the impact of a common fibular nerve lesion on motor control?
foot extensors and evertors paralysed:
- Peroneal muscles (lateral compartment)
- Tibialis anterior, EDL, and EHL
What test shows the motor effects of a common fibular nerve lesion?
foot drop
What is the impact of a common fibular nerve lesion on sensory control?
loss of sensation in:
- anterior and lateral side fo leg and dorsum of the foot
What is the impact of a tibial nerve lesion on motor control?
Paralysis of:
- Hamstrings
- all posterior muscles of the leg and sole of foot
- foot in a dorsiflexed and everted position
- Gastrocnemius
- Soleus
- Tibialis posterior
- FHL
- FDL
- Intrinsic foot flexors
- Interossi
- Lumbricals
What is the impact of a tibial nerve lesion on sensory control?
loss of sensation in the sole of the foot
What is the impact of whole sciatic nerve injury on motor control?
Paralysis of: - Hamstrings - All muscles below the knees Knee flexion affected Foot in plantar flexed position (foot drop)
What is the impact of whole sciatic nerve injury on sensory control?
sensory loss below the knee (except small medial area and foot - saphenous nerve)
What can cause whole sciatic nerve injury?
- pelvic fracture
- hip joint dislocation
- penetrating injuries
What is sciatica?
pain radiating from the posterior back into the buttock, posterior/lateral thigh and into the leg
What can cause sciatica?
- herniated lumbar intervertebral disc
- compression of the L5-S1 component of the sciatic nerve
What is the superior border of the femoral triangle?
inguinal ligament
What is the medial border of the femoral triangle?
adductor longus
What is the lateral border of the femoral triangle?
sartorius
What are the borders of the femoral triangle?
superior: inguinal ligament
medial: adductor longus
lateral: sartorius
Where is the dermatome of L1?
inguinal ligament
Where is the dermatome of L2?
lateral side of the thigh
Where is the dermatome of L3?
knee (lower medial side of thigh)
Where is the dermatome of L4?
big toe (medial side of leg, medial foot)
Where is the dermatome of L5?
middle 3 toes (lateral side of leg, mid dorsum of foot)
Where is the dermatome of S1?
little toe (lateral foot, and sole footprint area
Where is the dermatome of S2?
back of the upper leg and the whole thigh
Where is the dermatome of S3?
gluteal fold
What is compartment syndrome?
where the pressure in the muscle compartment is so high that the venous drainage becomes blocked, pressure can increase to the point of muscle ischaemia and death
What are the possible causes of compartment syndrome?
- fractures
- burns
- infections
- prolonged limb compression
What des compartment syndrome present with?
- pain
- muscle tenderness
- swelling
- 6 Ps
What are the 6 Ps?
- Pallor
- Pulselessness
- Paralysis
- Pershingly cold
- Pain
- Paraesthesia
What would be seen on examination of a case of compartment syndrome?
- swollen limb
- painful passive movement
- diagnosis on clinical suspicion
How would you treat compartment syndrome?
- relieve pressure
(all dressings, casts and splints should be removed) - open fasciotomy
What happens in a open fasciotomy?
surgical procedure:
- skin and deep fascia are opened alone the muscle compartment to relieve the pressure
