Neurological - Upper Limb Flashcards
Muscular clinical signs on general inspection
Wasting
Tremor
Fasciculations or pseudoathetosis (writhing)
Chorea
Myoclonus
Tardive dyskinesia
Non-muscular clinical signs on general inspection
Scars, hypomimia (reduced facial expression in Parkinson’s), ptosis and frontal balding (myotonic dystrophy), ophthalmoplegia (weakness/paralysis of extraocular muscles)
Objects or equipment on general inspection
Walking aids, prescriptions, any medical devices
Pronator drift = ?
Contralateral pyramidal tract lesion (UMN lesion where pronator muscles stronger than supinator muscles)
Types of abnormalities with tone + implications
Spasticity + rigidity = both increased tone
Spasticity = pyramidal tract lesions (e.g. stroke)
Rigidity = extrapyramidal tract lesions (e.g. Parkinson’s)
Spasticity = velocity-dependent so worse when you move the limb faster
Rigidity = velocity-independent so same regardless of how fast you move the limb
Spasticity typically associated with weakness
Rigidity split into cogwheel (tremor on top so intermittent increases in tone throughout movement) and lead pipe (uniformly increased tone)
- cogwheel - Parkinson’s
- lead pipe - neuroleptic malignant syndrome
Myotome + nerve for shoulder abduction?
C5 (axillary nerve)
Myotome + nerve for shoulder adduction?
C6/7 (thoracodorsal nerve)
Myotome + nerve for elbow flexion?
C5/6 (musculocutaneous + radial nerve)
Myotome + nerve for elbow extension?
C7 (radial nerve)
Myotome + nerve for wrist extension?
C6 (radial nerve)
Myotome + nerve for wrist flexion?
C6/7 (median nerve)
Myotome + nerve for finger extension?
C7 (radial nerve)
Myotome + nerve for finger abduction?
T1 (ulnar nerve)
Myotome + nerve for thumb abduction?
T1 (median nerve)
Muscle weakness patterns for UMN vs LMN lesion?
UMN - ‘pyramidal’ - upper limb EXTENSORS and lower limb FLEXORS disproportionately affected
LMN - ‘focal’ - only muscles directly innervated by damaged neurone(s)
Power scale (MRC scale)
0-5
- 0 - no contraction
- 1 - any contraction
- 2 - active movement, gravity eliminated
- 3 - active movement against gravity alone
- 4 - active movement against gravity + resistance
- 5 - normal power
Nerve roots for bicep, supinator, triceps reflexes?
Biceps - C5/6
Supinator - C5/6
Triceps - C7
UMN vs LMN lesions in reflexes?
HyPERreflexia = UMN
HyPOreflexia = LMN
C5-T1 dermatomes? (for sensory testing)
C5 = lateral aspect, upper arm
C6 = palm side of thumb
C7 = palm side of middle finger
C8 = palm side of little finger
T1 = medial aspect, upper arm (just above medial epicondyle)
Spinal cord segments for light touch, pin-prick, vibration, and proprioception?
Light touch = dorsal columns + spinothalamic tracts
Pin-prick (pain) = spinothalamic tracts
Vibration = dorsal columns
Proprioception = dorsal columns
Patterns of sensory loss?
Mononeuropathy = localised sensory problem
Peripheral neuropathy = GLOVE and STOCKING symmetrical sensory deficit
Radiculopathy = sensory loss in associated nerve root dermatomes
Spinal cord damage = sensory loss at and below nerve root level in dermatomes
Thalamic lesions (e.g. stroke) = contralateral sensory loss
Myopathy = symmetrical proximal muscle weakness
Abnormal finger-to-nose test interpretation?
Cerebellar pathology (ipsilateral)
- dysmetria - misses target (lack of coordination)
- intention tremor - tremor increases as they get closer to your finger (action tremor just the same throughout)
Interpretation of abnormal rapid/alternating movements test?
Dysdiadochokinesia = ipsilateral cerebellar pathology
Tone assessment technique
Hold hand + elbow
Shoulder circumduction + elbow flexion/extension + wrist circumduction
Upper limbs power assessment technique
Shoulders - flex elbows + abduct to 90 and apply resistance downward (abduction), then adduct to 45 and apply resistance outward (adduction)
Elbows - arms up like a boxer then pull away from pt (flexion) and push toward pt (extension)
Wrists - arms out straight with palms down, cock wrists back and try to press them down (extension), then flex wrists and try to pull them up (flexion)
Fingers + thumb - arms out palms down fingers out straight and try to push down (extension), then try to push them together (abduction), then palms up point thumb at ceiling and try to push down (abduction)
Sensory assessment technique
Light touch - cotton bud
Pin-prick - sharp end of neuro-tip
Vibration - 128 Hz tuning fork, ask for start and stop of vibration, only need to do IP joint of thumbs (move upwards if negative here)
Proprioception - move thumb joint with their eyes closed and ask for direction
Coordination assessment technique
Finger-to-nose = Position finger so patient has to fully stretch to reach, ask pt to touch their nose then your finger and then repeat as fast as they can
Dysdiadochokinesia = Place left palm on right palm, then left dorsal on right palm, then back and repeat as fast as they can
