Neuromusculoskeletal Diagnosis Flashcards
What is CN 1?
Olfactory nerve
What is CN 2?
Optic
How is CN 2 tested?
Snellen Chart for vision
Direct and Indirect Light Reflex
Accommodation
What nerves are tested with the six cardinal fields of gaze?
3, 4, and 6
What muscles are innervated by CN 3?
Levator palpebrae, inferior oblique, superior/medial/inferior rectus. Ciliary muscles and constrictor papillae
What muscles do CN 4 innervate?
Superior oblique
What muscles are innervated by CN 5?
Muscles of mastication
What reflexes are coordinated by CN 5?
Corneal
Jaw Jerk
Oculocardiac
Where does CN 5 provide sensory innervation to?
Face and anterior 2/3 of the tongue
What is trigeminal neuralgia also known as?
Tic Douloureaux
What is CN 6?
Abducens
What muscle is innervated by CN 6?
Lateral rectus
What is the key distinguishing factor between Bell’s palsy and stroke?
Forehead will be able to wrinkle with stroke
What is the sensory innervation of CN 7?
Taste to the anterior 2/3 of the tongue
What muscles are innervated by CN 7?
Muscles of facial expression
What is CN8?
Vestibulocochlear
What is CN9?
Glossopharyngeal
What reflexes is CN9 responsible for?
Gag
Uvula
Carotid
What muscles are innervated by CN9?
Stylopharyngeus to elevate pharynx and larynx
What is CN 10?
Vagus
What is CN11?
Spinal Accessory
What is CN 12?
Hypoglossal
What muscles are innervated by CN12?
Tongue muscles
What is Westphal’s Sign?
Absence of any DTR
DTR: Nerve and Nerve Root: Jaw Jerk
Trigeminal
CN 5
DTR: Nerve and Nerve Root: Biceps
Musculocutaneous
C5
DTR: Nerve and Nerve Root: Brachioradialis
Radial
C6
DTR: Nerve and Nerve Root: Triceps
Radial
C7
DTR: Nerve and Nerve Root: Patellar
Femoral
L4
DTR: Nerve and Nerve Root: Medial Hamstring
Sciatic
L5
DTR: Nerve and Nerve Root: Achilles
Tibial
S1
Superficial Reflex: Afferent & Efferent: Corneal
CN V
CN VII
Superficial Reflex: Afferent & Efferent: Pharyngeal
CN IX
CN X
Superficial Reflex: Afferent & Efferent: Cremasteric
Femoral nerve
Genitofemoral nerve
Superficial Reflex: Afferent & Efferent: Geigel’s
Femoral
Genitofemoral
Superficial Reflex: Afferent & Efferent: Plantar
Tibial
Tibial
Superficial Reflex: Afferent & Efferent: Abdominal
T7-T12
T7-T12
Superficial Reflex: Afferent & Efferent: Beevor’s
T7-T12
T7-T12
Where does the gallbladder refer to?
Right shoulder
Inferior scapula
Where does the pancreas refer?
Spine at T10 level
Where does the heart refer?
Left shoulder and medial left arm
Where do the intestines refer to?
Periumbilical
Where does the appendix refer to?
Early: Epigastric
Late: RLQ
Where does kidney refer to?
Flank
Where does ureter refer to?
Groin
Where does the bladder refer to?
Suprapubic area
What are the two types of median nerve entrapment?
Carpal tunnel syndrome
Pronator teres syndrome
How does carpal tunnel present?
Numbness and tingling in the first three digits, thenar atrophy, weak opponens pollicis
How does Pronator Teres Syndrome present?
Pain and paresthesia on the collar aspect of the forearm, lateral palm, and lateral digits
What test would help you diagnose pronator teres syndrome?
Pinch Grip Test
Where does Ulnar Nerve entrapment occur?
At the tunnel of Guyon and the Cubital tunnel
How does ulnar nerve entrapment present?
Pain, tingling, and numbness in the last 2 digits
Weakness of adductor pollicis and hypothenar atrophy
What is the clinical nerve for entrapment in the lower brachial plexus?
Klumpke’s paralysis
How does radial nerve entrapment present?
Loss of triceps reflex
Wrist drop
Decreased sensation to posterior arm, forearm, and posterolateral 3.5 fingers
How does entrapment of the long thoracic nerve present?
Scapular winging
How does entrapment of the dorsal scapular nerve present?
Flaring of the scapula
How does compression of the lateral femoral cutaneous nerve present?
Meralgia paresthetica
How does compression of the sciatic nerve present?
Sensory pain in the posterior buttocks, thigh, leg down to foot
Weak knee flexion
Decreased achilles reflex
How does compression of the tibial nerve present?
Burning paresthesia and decreased sensation on soles of feet and weak muscles of the foot
Aggravated by walking or standing
How does compression of the common fibular nerve present?
Pain in the lateral aspect of the leg
Weak peroneal muscle
How does compression of the deep fibular nerve present?
Can affect any and all of the 4 muscles of the anterior compartment (Tib ant, EHL, EDL, and peroneus tertius)
What is the term for the deformity where the fingertip is curled in and cannot straighten itself?
Mallet finger
Hyperflexion of the DIP and Hyperextension of the PIP is known as?
Swan Neck Deformity
Hyperextension of the DIP and hyperflexion of the PIP is known as?
Boutonnière Deformity
What is the term for an abnormal thickening under the skin of the palm and fingers that causes the last two fingers to curl into the palm?
Dupuytren’s Contracture
What causes trigger finger?
One of the flexor tendons for that finger becomes inflamed and swollen
What region of the brain is responsible for sensory and motor interpretation?
Cerebrum
What part of the central nervous system is responsible for balance and coordination?
Cerebellum
What part of the CNS is responsible for 2 point discrimination, vibration, and proprioception?
Posterior columns
What part of the CNS is affected by an UMNL?
Corticospinal (Pyramidal) tract
What is the corticospinal tract responsible for?
Voluntary motor control
What part of the CNS is responsible for pain and temperature?
Lateral Spinothalamic
What part of the CNS is responsible for interpreting crude light touch?
Anterior spinothalamic
What part of the CNS is responsible for balance reflexes and postural muscles?
Vestibulospinal
What part of the CNS is responsible for providing muscle tone and synergy to the proximal flexors of the extremities?
Rubrospinal
What is responsible for providing muscle tone and synergy to the voluntary extensor muscles?
Reticulospinal
What sensations are lost, and where, in a syringomyelia?
Pain and Temp.
Over the shoulders/back in a cape like distribution
What neuropathology is Charcot’s triad associated with?
Multiple sclerosis
What region of the CNS is affected by ALS?
Corticospinal tract and anterior horn
What is a brown sequard?
A hemisection spinal cord typically due to injury
How does a brown sequard present?
Ipsilateral loss of motor function and proprioception with contralateral loss of pain and temperature
What neuropathology is associated with scissor gait?
Cerebral palsy
What is the name of the inflammatory polyneuropathies of the PNS commonly seen after flu infection?
Gullain-Barre Syndrome
What pathology is tabes dorsalis associated with?
Tertiary syphilis
What is the typical presentation of Charcot Marie Tooth Disease?
Weakness of the foot and lower leg muscles – foot drop and a high-stepped gait
What percentage of the gait cycle is the stance phase?
60%
What percentage of the gait cycle is the swing phase?
40%
What muscles are involved in acceleration phase of gait?
Iliopsoas and rectus femoris
What muscles are involved in the deceleration of gait?
Hamstrings
What muscles are eccentrically contracted during heel strike?
Dorsiflexors and quadriceps
What muscles are involved in the foot strike portion of gait?
Abductors and plantar flexors
What makes up the triceps surae?
Gastrocnemius
Soleus
Plantaris
What muscles are involved in toe off?
Quadriceps and plantar-flexors
What does shuffling gait indicate?
Parkinson’s
What does scissor gait indicate?
Cerebral palsy
What does waddling gait indicate?
Muscular Dystrophy
What does steppage gait indicate?
Anterior compartment syndrome, L4 lesion, paresis of tib anterior
What does trendelenburg gait indicate?
Weak glute meds
What does slippage gait indicate?
Posterior column disease
What does circumduction gait indicate?
Stroke
What does antalgic gait indicate?
Pain
What does motor ataxic gait indicate?
Cerebellum issue or intoxicated