Neurological System Flashcards
Tone assessment (arm)
Assess in muscle groups of shoulder, elbow and wrist
1. Support patient’s arm by holding hand and elbow
2. Ask patient to relax and allow full control of their movement
3. Shoulder (circumduction), elbow (flexion/extension) and wrist (circumduction)
Tone abnormalities?
Spasticity
Rigidity
Cogwheeling hypotonia
Spasticity?
Pyramidal tract lesions
upper motor neurones exhibit inhibitory effect on lower motor neurones, so inhibition of upper MN = exaggerated muscle tone = hypertonia
Rigidity?
Extrapyramidal tract lesions (Parkinson’s)
Hypotonia?
Lower motor neurone lesion
Shoulder abduction myotome, muscle and instruction?
Myotome - C5
Muscles - deltoid
Instruction - flex elbows, apply downward resistance
Shoulder adduction myotome, muscles and instruction?
Myotome - C6 + C7
Muscles - teres major, lat. dorsi, pec. major
Instruction + bring elbows closer to body and apply upwards resistance
Elbow flexion myotome, muscles and instruction?
Myotome - C5/C6
Muscles - biceps brachii
Instruction - apply resistance by pushing forearm away
Elbow extension myotome, muscles and instruction?
Myotome - C7
Muscles - triceps brachii
Instruction - apply resistance by pushing towards
Wrist flexion myotome, muscles and instruction?
Myotome - C6/7
Muscles - flexors of wrist
Instruction - apply resistance downwards
Power scale?
MRC Muscle Power Scale
MRC 0/5?
No movement
MRC 1/5
Barest flicker of movement of muscle, though not enough to move the structure to which it’s attached
MRC 2/5
Voluntary movement which is not sufficient to overcome the force of gravity
MRC 3/5
Voluntary movement capable of overcoming gravity, but not applied resistance
MRC 4/5
Voluntary movement capable of overcoming resistamce
MRC 5/5
Normal strength
Biceps reflex
C5 + 6
Medial aspect of antecubital fossa
place non-dominant hand over tendon and tap thumb with tendon hammer
Triceps reflex?
C7 + 8
Superior to olecranon process of ulna
triceps tendon relaxed, rest elbow in 90 flexion on lap
Supinator reflex
C6
Brachioradialis tendon, found on posterolateral aspect of wrist, 4 inches away proximal to base of thumb
position 2 fingers over tendon, tap fingers with tendon hammer
LMN lesion?
Areflexia
UMN lesion?
Hyperreflexia
C5 sensation?
Lateral aspect of lower edge of deltoid muscle
C6 sensation?
Palmar side of thumb
C7 sensation?
Palmar side of middle finger
C8 sensation?
Palmar side of little finger
T1 sensation?
Medial aspect of antecubital fossa, proximal to medial epicondyle
Tone steps (leg)
- Leg roll
- Leg lift - quickly lift leg off bed at knee joint, heel should remain in contact with the bed
- Ankle clonus - quickly dorsiflex and partially evert foot, clonus is felt but more than 5 is normal
T2 sensation?
Axilla
Hip joint flexion muscles and nerve?
Psoas major
Iliacus (sartorius, rectus femoris, pectineus)
Femoral nerve
Hip extension muscle and nerve?
Gluteus maximus
inferior gluteal nerve
Hip abduction muscles and nerve?
Gluteus medius and gluteus minimus
superior gluteal nerve
Hip adduction muscles and nerve?
Adductor longus, adductor brevis, adductor magnus (pectineus, gracilis)
obturator nerve
Internal rotation muscles
Obturators externus (all adductors, semitendinosus, semimembranosus)
External rotation muscles?
Piriformis, obturator internus, gemellus superior and inferior, quadratus femoris
Knee joint flexion muscles?
Biceps femoris, semitendinosus, semimembranosus and gracilis
Knee joint extension muscles?
Quadriceps femoris
Tremdelenburg test?
- Position hands on iliac crests
- Ask patient to life each foot in turn off of floor
- When right foot is raised, left hip abductors are tested. When left foot is raised, right hip abductors tested.
if there is weakness in abductors, will be unable to stabilise hip on weight bearing femur so pelvis will sag towards unsupported side
Quadriceps examination?
Knee extension - bend knee and ask patient to straighten whilst applying resistance
femoral nerve
Hamstrings examination?
Instruct patient to begin flexing the knee towards themselves against resistance
sciatic nerve
Assessing doriflexion?
Resist by pushing foot downwards
Tibialis anterior, extensor hallucis and extensor digitorum longus
Innervated by deep fibular nerve
Assessing plantarflexion?
Resist by pushing foot upwards and ask patient to point foot downwards
Innervated by tibial nerve (S1-2)
Assessing inversion?
Place hand laterally and instruct patient to push against applied resistance
takes place at subtalar joint
Assessing eversion?
Place hand medial and instruct patient to push against applied resistance
Patellar reflex tendon assessment?
Assess knee jerk (L3-L4)
legs hanging freely over base
Jendrassik manoeuvre (gritting teeth and flexing both sets of fingers)
Tap patellar tendon with tendon hammer
Ankle jerk reflex
S1-2 at Achilles tendon
Support leg so hip is slightly abducted, knee is flexed and ankle dorsiflexed
Sciatica
Caused by herniated lumbar intervertebral disc which compresses on L5-S1 component of sciatic nerve
Borders of femoral triangle
- Inguinal ligament (superior)
- Adductor longus (medial)
- Sartorius (lateral)
Dermatomes L1-S3 innervation?
L1 Area of inguinal ligament
L2 Lateral side of thigh
L3 Lower medial side of thigh
L4 Medial side of leg, medial foot and great toe
L5 Lateral side of leg, mid dorsum of foot and middle three toes
S1 Little toe, lateral foot, and sole footprint area
S2 Back of upper leg and whole thigh
S3 Area of gluteal fold
Compartment syndrome meaning?
Pressure in muscle compartment is so high that the venous drainage becomes blocked - pressure increases such that muscle ischaemia and death can arrive
Femoral nerve lesion motor loss?
Quadriceps paralysis - weakness of knee
Difficulty climbing up or down stairs
Femoral nerve lesion sensory loss?
Anterior and medial thigh, medial side of leg and medial border of foot.
Saphenous nerve affected.
Obturator nerve lesion motor loss?
Paralysis of all adductors
Cross legging affected
Obturator nerve lesion sensory loss?
Pelvic disease, ovarian tumours may cause pain on medial thigh
Medial cutaneous nerve of thigh
Common fibular nerve lesion motor loss?
Foot extensors and evertors paralysed
Foot flop
Perineal muscles (lateral compartment)
Tibialis anterior, EDL and EHL
Common fibular nerve lesion sensory loss?
Loss in anterior and lateral side of leg and dorsal of foot
Tibial nerve lesion motor loss?
Hamstrings and all posterior muscles of leg and sole of foot
Foot - in dorsiflexed and everted position
Gastrocnemius, soleus, tibialis posterior, FHL + FDL
Intrinsic foot flexors, interossei and lumbricals
Tibial nerve lesion sensory loss?
Sole of foot
Compartment syndrome causes?
Fractures, burns, infections or prolonged limb compression
Present with pain, muscle tenderness and swelling
Compartment syndrome 6 Ps?
Pallor
Pulselessness
Paralysis
Perishingly cold
Pain
Paraesthesia
Compartment syndrome examination?
Swollen limb and passive movement painful
Compartment syndrome treatment?
Relieve pressure, all dressings, casts and slings removed
Open fasciotomy - surgical procedure where skin and deep fascia opened along the length of a muscle compartment to relieve pressure
