Neurological System (Upper limb) Flashcards
In the upper limb which muscle group tone should be assessed?
Shoulder
Wrist
Elbow
How is tone assessed for the shoulder?
Circumduction
How is tone assessed at the elbow joint?
Flexion and extension
How is tone assessed in the wrist?
Circumduction
What abnormalities are detected when assessing the tone at each joint?
Spasticity
Rigidity
Cogwheeling
Hypotonia
Hypotonia is associated with which type of motor neurone lesion?
Lower motor neurone
Spasticity is associated with which type of tract lesion?
Pyramidal tract
Pyramidal tract lesions are associated with what type of abnormality?
Spasticity
What does hypertonia arise with an upper motor neurone lesion?
Upper motor neurones exhibit an inhibitory effect on the lower motor neurones, thus if this inhibition is lost, muscle tone is exaggerated
What abnormality is associated with extrapyramidal tract lesions?
Parkinson’s disease
Which myotome is associated with shoulder abduction?
C5
Which muscle group is associated with shoulder abduction?
Deltoids
How is the power of shoulder abduction assessed?
Flex elbows, and apply a downwards force, to which resistance is assessed
Ensure that the shoulder joint is isolated
When assessing shoulder adduction which myotome is being assessed?
C6/C7
Which muscles are associated with shoulder adduction?
Teres major
Latissimus dorsi
Pectoralis major
How is the power of shoulder adduction assessed?
Bring elbows closer to the body and apply upwards resistance.
Which myotome is associated with elbow flexion?
C5-C6
Which muscle group is associated with bicep flexion?
Biceps brachii
How should elbow flexion be assessed (power)?
Apply resistance by pushing forearm away.
Which muscle is concerned with elbow extension?
Triceps brachii
Which myotome is concerned with elbow extension?
C7
How is the power of elbow extension assessed?
Apply resistance by applying a pushing force
Which myotome is concerned with wrist flexion?
C6/C7
Which scale is used to assess power?
MRC muscle power scale
What does a score of 0 represent on the MRC muscle power scale?
No movement
A score of 1 on the MRC scale represents what?
Barest flicker of movement of the muscle, though not enough to move the structure to which it’s attached
A score of 2 on the MRC scale represents what?
Voluntary movement which is not sufficient to overcome the force of gravity
What score is associated with voluntary movement capable of overcoming gravity but not applied resistance?
3
A score of 4 on the MRC scale represents what?
Voluntary movement capable of overcoming resistance
What nerve roots are associated with the biceps reflex?
C5
C6
How is the biceps reflex conducted?
Locate the biceps tendon, residing on the medial aspect of the antecubital fossa, place thumb of non-dominant hand over the tendon and tap your thumb with the tendon hammer
Which nerve roots are associated with the triceps reflex?
C7
C8
Which nerve roots are associated with the supinator reflex?
C6
How is the triceps reflex elicited?
Triceps tendon relaxed, rest the patients elbow in 90 degree flexion on their lap, locate the triceps tendon, found superior to the olecranon process of the ulna
Where is the triceps tendon located?
Superior to the olecranon process of the ulna
Which tendon is associated with the supinator reflex?
Brachoradialis tendon
Where is the supinator reflex elicited?
Locate the brachioradialis tendon which can be found on the posterolateral aspect of the wrist - 4 inches away proximal to the base of the thumb. Position two fingers over the tendon, tap your fingers with the tendon hammer.
Areflexia is associated with which type of lesion?
Lower motor neurone lesion
Hyperreflexia is associated with which type of lesion?
Upper motor neurone lesion
The C5 dermatome is associated with which aspect of the upper arm?
Lateral aspect of the lower edge of the deltoid muscle (regimental badge)
The regimental badge is associated with which dermatome?
C5
The C6 dermatome is associated with which part of the upper limb?
The palmar side of the thumb
The palmar side of the the thumb is associated with which dermatome?
C6
The C7 dermatome is associated with which aspect of the upper limb?
The palmar side of the middle finger
Which dermatome is implicated in the palmar side of the middle finger?
C7
The C8 dermatome is associated with which aspect of the upper limb?
Palmar side of the little finger
The palmar side of the little finger is associated with which dermatome?
C8
Which dermatome is associated with the medial aspect of the antecubital fossa?
T1
The T1 dermatome is associated with which aspect of the upper limb?
The medial aspect antecubital fossa proximal to the medial epicondyle
The axilla is associated with which dermatome?
T2
