Neurological Testing Flashcards
Neuro assessment order for upper limb?
Observation:
-bone and soft tissue, tone, texture, wasting, temperature
Active ROM:
- ease of movement, full ROM
Passive ROM:
-tone, texture of muscle, end feel
Coordination:
-finger to nose(dysmetria), disdiadochokenesia
Sensory testing:
-DCML and Spinothalamic tracts
-dermatomes
Reflexes:
-tendon reflexes
-pathological reflexes
Muscle testing:
-myotomes
Causes of nerve injury?
Stretched induced Ischemia
Compression induced ischemia
Direct pressure
Repetitive micro trauma
Factors influencing the degree:
-Severity of injury
-Duration of exposure to compressive forces/ MOI
What is Muscle tone?how can you assess this?
Resistance to passive movement of a joint.
Assess:
Observing how limb is held at rest.
Palpate muscle belly.
Assessing resistance to PROM
Hypertonia:
Spasticity
Rigidity
Hypertonia?
UMNL LESION
Spasticity: UMNL LESION
Arms- increased tone in flexors and adductors
Legs- increased tone in extensors
Ex: Knife Clasp phenomenon
Rigidity: a Basal Ganglia dysfunction.
Affects agonists and antagonists equally= Lead pipe rigidity
Possible underlying tremor=Cogwheel rigidity
Paratonia?
FRONTAL LOBE LESION OR CEREBRAL DISEASE ex: ant cerebral artery occlusion or Parkinson’s.
Rigidity when limbs are moved too rapidly
MC in elderly
Hypotonia
LMNL*
Flaccidity
Excessive floppiness-> reduced resistance
Muscle strength grading:
5 = normal
3= gravity
0= no contraction
Axillary nerve innervates?
Root: C5-C6
Deltoids
Gh joint
Teres minor
Musculocutaneous innervates?
Root:C5,C6,C7
Biceps brachii
Brachialis
Coracobrachialis
Skin of lateral forearm
Radial Nerve innervation
Root: C5-T1
Triceps
Anconeus
Brachiradialis
Extensors of forearm
Entrapments:
Arcade of froshe by supinator
Wartenberg syndrome by brachioradialis and extensor carpi radialis longus.
Ulnar Nerve innervation?
Root: C7-T1
Flexor carpi ulnaris
All 8 interossei
2 medial lumbricals
Digiti minimi
Flexor digitorum profundus medial half
Entrapment:
Cubital tunnel-2nd mc compressive neuropathy, M>F
Arcade of struthers
Tunnel of Guyon
Handle bar palsy- compressed hook of hamate/guyon
Median nerve innervation?
Root : C5-T1
Supplies all anterior forearm muscles expect flexor carpi ulnaris and digitorium profundus ulnar half.
2 lateral lumbricals
Entrapment:
Lovers paralysis
Oath hand- patient is unable to make a fist(unable to flex digit 1st/2nd)
Anterior interossei compression- inability to perform “OK” sign (FDP/FPL)
Carpal tunnel- d/t diabetes, hypothyroidism, pregnancy
Bottle sign- decreased thumb abduction
Neuro Assessment order for lower limb?
Observation:
Gate-and how lower and upper Limb is held.
Palpation :
-Outline tone, texture, temperature, lumps, and bumps
Active range of motion :
Passive range of motion :
End feel and play, tone at various speeds.
Coordination:
-Heel to shin toe to finger rapid movement tapping, wiggling toes.
Sensory testing :
-Dermatomes and cutaneous patterns
-DCML
-Spinothalamic
Reflexes :
Tendon reflexes:
L4-knee(infrapatellar)
L5-tib post and med hamstring
S1- Achilles and lat hamstring
Pathological reflexes:
Babinski, Hoffman, Gordon’s Chaddocks, Oppenheimer, Clonus
Muscle testing :
Illiohypogastric:
roots -T12-L1
Sensory
Innervation:
Sensory for gluteus minimus and medius
Cutaneous over lower abdomen
Entrapped:
Sensory loss over lower, abdomen and anterior lateral glute
Ilioinguinal
Root: T12-L1
Sensory
Innervation :
Cutaneous, innervation of upper medial thigh , root of the penis scrotum/labia majora, and mons pubis.
Entrapment :
Deep ache in the groin region, radiating to lower abdomen
Genitofemoral
Root: L1-L2
Mixed nerve
Motor : Genito part
Cremaster muscle spermatic cord, skin of scrotum
Sensory : femoral part
Saddle area and above sartorius muscle origin.
Entrapment :
Decreased or loss of cremasteric reflex
Decreased or loss sensory
DDX cauda equina
Lateral femoral cutaneous
Root: L2-L3
sensory
Sensory to lateral thigh
Entrapment:
Under inguinal ligament or TFL
Meralgia paresthetica:
More common in men 20 to 60 years old
Positive Tinel’s test over ASIS or inguinal ligament
Nerve to psoas
Root: L2-L3
Motor to psoas muscle
Obturator nerve
Root: L2-L4
Mix nerve
Motor:
Adductor longus, brevis, gracilis hip joint
Cutaneous :
Inner thigh
entrapment:
Paralysis or weakness of addiction
Sensory changes middle thigh
Chronic irritation leads to medial knee pain
Howship Romberg syndrome-operator neuralgia due to hernia(pain on abduction of the thigh, external rotation of the leg, abdominal pain with mild bowel obstruction)
Causes-pelvic fracture. Tumor operator, hernia
DDX: cauda equina, MS
Femoral nerve
Root: L2-L4
Mixed
Motor :
Psoas, Iliacus, pectineus, sartorius, all quadriceps
Cutaneous :
Saphenous nerve(below the knee medially)
Anterior thigh and lateral
Entrapment:
Weakness or paralysis of the knee extensors
Abolished patellar reflex L4
Decreased hip flexion
Anesthesia of anterior thigh, and saphenous branch.
Causes:
Compression under inguinal ligament post surgery
DDX
Multiple sclerosis
L3 or L4 nerve root compression
Proximal diabetic mono neuropathy
Old age, hip osteoarthritis, fear, avoidance
Saphenous nerve
Root: L3-L4
Sensory
A Continuation of the femoral nerve
Sensory to medial lower leg under knee
Motor is not affected
Entrapment, medial, knee, pain, and lower leg.
After prolonged, walking, standing, quadricep exercises walking upstairs.
Causes
nontraumatic
Traumatic
Post surgical
Compression of the nerve due to tight shoes/boots
Superior gluteal nerve
Root: L4-S1
Motor:
gluteus, medius and minimus and tensor fascia lata.
Trendelenburg sign is seen it compromised.
Ddx: root lesion
Inferior gluteal nerve
Root: L5-S2
Motor
Gluteus maximus
Extensor lurch -throwing the head forward from trunk and pelvis due to damage to gluteal maximus.
Nerve to piriformis
Root: S1-S2
Motor
Innervation to piriformis
Entrapment:
Pain in medial buttocks
Piriformis syndrome :
Compression of the sciatic nerve under the piriformis muscle
