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Neuro3 > Neurological Testing > Flashcards

Neurological Testing Flashcards

1
Q

Neuro assessment order for upper limb?

A

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

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2
Q

Causes of nerve injury?

A

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

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3
Q

What is Muscle tone?how can you assess this?

A

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

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4
Q

Hypertonia?

A

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

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5
Q

Paratonia?

A

FRONTAL LOBE LESION OR CEREBRAL DISEASE ex: ant cerebral artery occlusion or Parkinson’s.
Rigidity when limbs are moved too rapidly
MC in elderly

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6
Q

Hypotonia

A

LMNL*
Flaccidity
Excessive floppiness-> reduced resistance

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7
Q

Muscle strength grading:

A

5 = normal
3= gravity
0= no contraction

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8
Q

Axillary nerve innervates?

A

Root: C5-C6
Deltoids
Gh joint
Teres minor

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9
Q

Musculocutaneous innervates?

A

Root:C5,C6,C7
Biceps brachii
Brachialis
Coracobrachialis
Skin of lateral forearm

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10
Q

Radial Nerve innervation

A

Root: C5-T1
Triceps
Anconeus
Brachiradialis
Extensors of forearm
Entrapments:
Arcade of froshe by supinator
Wartenberg syndrome by brachioradialis and extensor carpi radialis longus.

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11
Q

Ulnar Nerve innervation?

A

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

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12
Q

Median nerve innervation?

A

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

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13
Q

Neuro Assessment order for lower limb?

A

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 :

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14
Q

Illiohypogastric:

A

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

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15
Q

Ilioinguinal

A

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

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16
Q

Genitofemoral

A

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

17
Q

Lateral femoral cutaneous

A

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

18
Q

Nerve to psoas

A

Root: L2-L3
Motor to psoas muscle

19
Q

Obturator nerve

A

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

20
Q

Femoral nerve

A

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

21
Q

Saphenous nerve

A

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

22
Q

Superior gluteal nerve

A

Root: L4-S1
Motor:
gluteus, medius and minimus and tensor fascia lata.

Trendelenburg sign is seen it compromised.

Ddx: root lesion

23
Q

Inferior gluteal nerve

A

Root: L5-S2
Motor
Gluteus maximus
Extensor lurch -throwing the head forward from trunk and pelvis due to damage to gluteal maximus.

24
Q

Nerve to piriformis

A

Root: S1-S2
Motor
Innervation to piriformis

Entrapment:
Pain in medial buttocks

Piriformis syndrome :
Compression of the sciatic nerve under the piriformis muscle

25
Q

Sciatic nerve

A

Root: L4-S3
Motor mixed
Common perineal part: short head of biceps femoris
Tibial nerve part : semitendinosis, semimembranosus, long head of bicep femoris, adductor Magnus.

Entrapment:
Weakness of knee flexors
Perineal part : common peroneal, nerve compression >sensation lateral inferior to knee.
Foot drop due to repetitive micro trauma

Causes
Direct trauma
Gun shot
Stabbing
Pelvic fracture
Surgery
Piriformis syndrome
Chronic Compression

26
Q

Common peroneal nerve

A

Divides into:
Superficial peroneal nerve
Deep, peroneal nerve

Damage to common peroneal:
Direct trauma
Repetitive microtrauma-prolonged knee compression
Crossing legs
Fracture
Diabetic mono or poly neuropathy
Compartment syndrome

27
Q

Superficial peroneal nerve

A

Continuation of the common peroneal nerve
Mixed
Cutaneous :
Anterior lateral lower leg, and most of dorsum of the foot .

Motor :
Peroneal longest in brevis

Presentation:
Patient unable to evert and plantarflex or sensory changes to lateral shin

DDX : L5,S1 root lesion

28
Q

Deep, peroneal nerve

A

Continuation of the common peroneal nerve
Mixed
Cutaneous :
Between first and second toes
Motor :
Anterior tibial compartment -tibialis anterior, ext dig longus, hallucis longus, peroneus tertius
-Dorsum of the foot-ext dig brevis

Presentation :
patient will find difficult to dorsiflex ankle, presenting with a foot drop/slap gait and loss and sensation of the first web

Entrapment :
Under extensor retinaculum dorsum of the foot or by a Talar spur

29
Q

Tibial nerve

A

Root: L4-S2
Mixed
Motor :
Popliteus gastrocnemius Soleus plantaris, flexor hallicus longus
Reflex- achilles
Cutaneous :
Sural nerve- lateral ankle and foot

Presentations :
Weakness or paralysis of plantar flexors, inversion muscles and intrinsic foot muscles
Reflects of Achilles is decreased
Sensory changes to the sole of the foot and lateral ankle and foot .

30
Q

Medial plantar

A

Root: L5-S2
Mixed
Motor :
Abd hallucis, flex hallucis brevis, 2 med lumb

Cutaneous :
Medial sole of foot , plantar, medial toes, and dorsal aspect of distal phalanges

31
Q

Lateral plantar

A

Root: S1-S2
Mixed
Similar to ulnar nerve in How distributes.
Motor :
Abd dig min, add dig min, interossei, lat lumbricals

Cutaneous :
Lateral first and a half toes

32
Q

Most sensitive regions?

A

Ankle
Post genu
Groin
Axilla
Post cervical

33
Q

Pyramidal lesions?

A

Originate in the cerebral cortex
Travel through pyramids of the medulla
Responsible for voluntary muscle control
Occur in any damage to the brain or spinal cord.
2 tracts:
Corticospinal
Corticobulbar

Causes:
MS
Stroke
Abscess
Tumors
Hemorrhages
Meningitis
Trauma

Presentation:
Motor deficits of contralateral
UMNL
Increased muscle tone
Hyperreflexia
Weakness
Clonus
Babinski

34
Q

Extrapyramidal lesions?

A

Do not start in the cerebral cortex.
Responsible for involuntary control and modulation.
Upper motor neurons are located within the nuclei in the brain stem and send their axons down the spinal cord and are involved in the control of movements and coordination.

Causes:
Parkinson’s or Huntingtons

Presentation:
1)Parkinson’s
Bradykinesia
Rigidity
Tremor
2) chorea- Huntingtons
3) athetosis- hand spasms
4) dystonia-dragging legs, dysarthria, uncontrolled blinking, muscle spasm

35
Q

Cerebellar vs Basal ganglia

A

Cerebellar:
Awkwardness of intended movements.
Intention tremor, and ataxia.

Basal ganglia :
Involuntary movements
Resting tremor
Chorea
Hemiballismus

Neuro3 (12 decks)

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