Pediatric Neuromuscular

Question 1

If a newborn has decreased tone in an arm, what are two likely differentials?

Answer 1

Clavicle fracture

Brachial plexus injury

Question 2

Clavicle exam for newborn

Answer 2

Palpate clavicle while moving the arm superiorly

Feel for crepitus

Question 3

Tests to assess muscle tone in newborn

Answer 3

Pull test
Ventral suspension
Vertical suspension

Question 4

Barlow’s maneuver

Answer 4

Adduct leg and apply downward pressure to test for posterior femoral dislocation
Positive is a “clunk”

Question 5

Ortolani’s maneuver

Answer 5

Abduct thigh, exert lever motion to push head of femur back toward acetabulum to see if it “clunks” in
Test for subluxation or dislocation

Question 6

Allis sign

Answer 6

Feet flat, knees and hips flexed, assess height of knees

If one knee is lower than other, Allis sign is positive (short femur or dislocation)

Question 7

Suck reflex

Answer 7

Place gloved finger in babies mouth and see if they suck on it, or from observation of feeding, or good report from nurses

Question 8

Plantar and palmar grasp reflexes

Answer 8

Place a finger in the middle of the hand and assess for grasp; also on the sole of the foot for grasp

Question 9

Moro reflex

Answer 9

Release the arms after the pull test, they should grab the air

Question 10

Physical skills of a toddler

Answer 10

Walks alone 
 Pulls toys behind when walking 
 Begins to run 
 Stands on tiptoe 
 Kicks a ball

Question 11

Gower’s sign

Answer 11

Child getting up by having to use his arms and walking his hands up his legs to get up
Classic sign for DMD

Question 12

What is the most important part of a newborn neuromuscular exam?

Answer 12

OBSERVATION