Neurology Peripheral Examination Flashcards
what should be looked at on inspection of upper limbs
symmetry, muscle wasting, fasciculations
abnormal posturing
pronator drift
what does muscle wasting and fasciculations suggest?
LMN lesion
what is the posture of a UMN lesion?
shoulder adduction
elbow/wrist flexed, pronated
what is an example of a UMN lesion?
stroke
how do you test for pronator drift?
ask patient to stretch arms out in front of them
palms facing upwards
close eyes and keep arms there
if hands drift down and protate= positive result
what is pronator drift a sign of?
UMN lesion
contralateral pyramidal tract lesion
what does supinator catch in the wrist suggest?
early sign of increased tone
what is power graded out of?
5
what phrases are best to use when testing power?
push me away
pull me towards you
what should be tested in upper limb power?
shoulder abduction elbow flexion elbow extension wrist flexion wrist extension finger flexion finger extension finger abduction finger adduction thumb abduction thumb opposition
how should each movement of power be tested?
compare immediately with the other side for each movement
what root and nerve allow shoulder abduction?
C5
axillary nerve
what root and nerve allow elbow flexion?
C5/C6
musculocutaneous
what root and nerve allow elbow extension?
C7
radial
what root and nerve allow wrist extension?
C6, C7
radial
what root and nerve allow finger extension?
C7
radial
what root and nerve allow finger flexion?
C8
median and ulnar
what root and nerve allow thumb abduction/ opposition?
T1
median
what root and nerve allow finger abduction/adduction?
T1
ulnar
what root causes the biceps reflex?
C5/C6
what root causes the triceps reflex?
C7
what root causes the supinator jerk?
C5/C6
how should the biceps reflex be tested?
strike thumb over tendon
how should triceps and supinator reflex be tested?
strike directly
what should be tested on coordination?
piano playing- hold hands out and wiggle fingers
hand slapping test for dysdiadokinesis
finger nose test
what does piano playing sign show?
difficult in UMN lesion
parkinson’s
what do hand slapping test and finger nose test check for ?
cerebellar ataxia
how do you check the sensation
first with cotton wool (light touch) then neurotip (Pain)
with eyes closed
move from side to side- does it feel same on both sides
where should upper limb sensation be checked and what are the roots?
above shoulder tip (C4) regimental badge area (C5) tip of thumb (C6) tip of the middle finger (C7) tip of the little finger (C8) medial mid-forearm (T1)
how do you check vibration sensation?
patient close their eyes
let know when detect vibration
use sternal reference point
place on finger distal interphalangeal joint
say yes when feel it and when it stops- stop it yourself
only move proximally if cannot feel the sensation
repeat on other arm
what should you do with the neurotip after use?
sharps bin
what should you offer to do after testing for other sensations?
temperature sensation using hot and cold test tubes
which tuning fork is used to test vibration?
128 Htz- “128 lets vibrate”
how do you test joint position sensation?
use middle finger DIP joint
immobilise middle phalynx with one hand
hold distal finger by sides
show movement first then close eyes and tell if finger move up or down or not sure
randomly move finger up or down 3-4 times
repeat other arm
when is vibration sense lost
lost early in peripheral neuropathy
what are the concluding remarks on further examinations of upper limb neurology?
i would like to perform a more detailed examination of the neurology of the hands, then go on to complete a full neurological examination
investigation: nerve condution studies, imaging (CT or MRI)
what are the clinical examination features in a LMN lesion? tone power reflexes plantar coordination other features
tone normal or decreased power decreased reflexes reduced plantars down co-ordination normal muscle wasting and fasciculation
what are the clinical examination features in a UMN lesion? tone power reflexes plantar coordination other features
tone increased (spastic) power decreased reflexes brisk plantars up coordination decreased clonus
what are the clinical examination features in a extrapyramidal lesion? tone power reflexes plantar coordination other features
tone increased (rigid) power normal reflexes normal plantars down coordination decreased resting tremor, bradykinesia, postural instability
what are the clinical examination features in a cerebellar lesion? tone power reflexes plantar coordination other features
tone decreased power normal reflexes normal plantars down coordination very low intention tremor, nystagmus, cerebellar speech
what is a grade 5 power
normal
full power against resistance
what is a grade 4 power
reduced power
able to move against some resistnace
what is a grade 3 power
able to move against gravity
unable to move against resitance
what is a grade 2 power
unable to move against gravity
able to move if gravity eliminated
what is a grade 1 power
visible flicker of muscle contraction but no movement across joint
what is a grade 0 power
no muscle contraction
