Neurology Flashcards
Scapulothoracic elevation
Superior trapezius, levator scapulae, rhomboids
Scapulothoracic Depression
Inferior trapezius, pectoralis minor, serratus anterior
Scapulothoracic Protraction
Pectoralis minor, serratus anterior
Scapulothoracic Retraction
Rhomboids, middle trapezius, latissimus dorsi
Scapulothoracic Rotation
Glenoid fossa faces upwards or downwards as scapula rotates
Superior trapezius, inferior trapezius, serratus anterior - up
Pectoralis minor, latissimus dorsi, rhomboids and levator scapulae - down
Scapulothoracic movements
Elevation Depression Protraction Retraction Rotation
Glenohumeral flexion
Pectoralis major, deltoid (anterior fibres)
Glenohumeral extension
Deltoid (posterior fibres)
Glenohumeral abduction
Supraspinatus initially and then central deltoid
Glenohumeral adduction
Pectoralis major, latissimus dorsi
Glenohumeral internal rotation
Subscapularis
Glenohumeral external rotation
Infraspinatus
Glenohumeral movements
Flexion Extension Abduction Adduction Internal and external rotation
Elbow joint flexion
Biceps, brachialis, brachioradialis (pronator teres)
Elbow joint extension
Triceps
Radio-ulnar joint supination
Supinator, Biceps
Radio-ulnar joint pronation
Pronator quadratus, Pronator teres
Radio-ulnar movements
Supination and pronation
Muscle power scale
0/5: no movement
1/5: Barest flicker of movement of the muscle, though not enough to move the structure to which it’s attached
2/5: Voluntary movement which is not sufficient to overcome the force of gravity.
3/5: Voluntary movement capable of overcoming gravity, but not any applied resistance.
4/5: Voluntary movement capable of overcoming “some” resistance
5/5 Normal strength
Atrophy
Lower motor neurone lesion
Muscle tone
Amount of tension in muscle
Reflex
Spinal segmental reflex arc
Biceps tendon reflex
C5 & C6
Triceps tendon reflex
C7 & C8
Brachioradialis (supinator) reflex
C5 & C6
Reflex grading
0 - absent 1+ - decreased 2+ - normal 3+ - hyper-reflexic 4+ - clonus
Upper Brachial injury
Extreme lateral flexion of the head
Stretch on upper roots (C5 & C6) and or superior trunk
Erb’s palsy
Lower Brachial injury
When upper limb is pulled superiorly
Stretch on lower roots (C8 & T1) and or inferior trunk
Klumpke’s Palsy
Small muscles of the hand are affected
May get clawed hand and wasting
Musculocutaneous
Stab wound to upper arm
Lateral forearm sensory loss
Weak elbow flexion
Weak wrist supination
Absent bicep reflex
Wasting of Biceps
Axillary
Fracture of surgical head of humerus
Compression injury from shoulder dislocation or crutches in armpit
Sergeant’s patch
Markedly weak shoulder abduction (15-90 degrees)
Weak shoulder flexion, extension and external rotation
Wasting of Deltoid
Median
Supra condylar fracture of humerus
Compression in carp
Median distribution of hand and thenar eminence
Weak forearm pronation Weak wrist flexion Weak wrist abduction Weak finger flexion (DIP joint of ring and littler finger preserved) Weak thumb abduction and opposition
Wasting of anterior forearm
Wasting of thenar eminence
Hand of Benediction (on attempted finger
flexion)
Radial
Fracture of proximal/shaft humerus, proximal radius
Compression from crutches on armpit sleeping on arm or armpit on chair (Saturday night palsy)
Posterior arm and forearm
Radial area of hand
Weak elbow extension
Absent triceps reflex
Weak wrist extension
Weak finger MCP joint extension
Wasting of triceps and posterior compartment of forearm Wrist drop (on attempted wrist extension)
Ulnar
Medial epicondylar fracture
Compression at Guyons tunnel in wrist
Ulnar distribution of hand and hypothenar eminence
Weak wrist flexion
Weak wrist adduction
Weak finger flexion of ring and little finger at the MCP and DIP joints
Weak extension at the IP joints in ring and little finger
Weak finger abduction, adduction and opposition
Wasting of hypothenar eminence and intrinsic muscles of hand Claw Hand (on attempted finger flexion)
Hip joint movements
Flexion extension
Abduction adduction
Medial lateral rotation
Circumduction
Knee joint
Flexion extension
Slight medial and lateral rotation
Ankle joint
Dorsi and plantarflexion
Intertarsal joints
Inversion eversion
Supination pronation
Tarsometatarsal movements
Limited sliding
Metatarsalphalangeal movements
Flexion extension
Limited other
Interphalangeal movements
Flexion extension
Trendelenburg test
First the subject is asked to stand on both legs. Both right and left pelvis should remain at same level without any tilt. The examiner should stand behind the subject and feel their pelvis. Then ask the subject to raise one leg off the ground. The pelvis should remain horizontal on one leg. If the pelvis on the unsupported side drops downward then the Trendelenberg test is said to be positive. A positive test indicates a loss or weakness of the motor function of the hip abductors in the leg the subject is standing on.
Femoral nerve injury
L2-4
Quadriceps paralysis
Weakness of knee
Difficulty up or down stairs
Anterior and medial thigh, medial side of leg, medial border of foot - big toe
Obturator nerve injury
L2-4
Paralysis of all adductors
Insignificant loss on medial side of thigh
Common fibular nerve injury
L4-S2
Foot extensor and evertors paralysed
Foot drop
Anterior and lateral side of leg and dorsum of foot
Tibial nerve injury
L4-S3
Hamstring and all muscles of back of leg and sole of foot
Foot in dorsiflexion and everted
Sole of foot
Sciatic nerve injury
Hamstring and all muscle below the knee are paralysed
Knee flexion
Plantarflexed
Below knee except on narrow area except on medial and big toe
Sciatica
Pain from lower back into buttock, posterior/lateral thigh into leg
