Peripheral nerves exam Flashcards
What is the first steps?
Introduce self
Ask name and DOB
Ask for permission + explain
Ask if they are in any pain?
What do you inspect the patient for in the general inspection?
Scars
Wasting
Involuntary movements
Fasciculations
Tremor
What do you check for after the general inspection?
Pronator Drift
Get them to put their arms out in front of them and close their eyes prone and supine for a few seconds and see if there is drift
What do you assess after pronator drift?
Tone
Ask them to let arms go floppy
Support arms and lift shoulder , below and wrist
Compare each side
What do you assess after tone?
Shoulder Strength
Get them to put arms up in front of them . Press down on shoulders and push up on them and tell them to resist
What do you assess after shoulder strength?
Elbow strength
Get them to put arms out transverse in front of them and press the back and front of their arms and get them to resist
What do you assess after elbow strength?
Wrist strength
Get the patient to put their arms out in front of them and cock their wrists back , resist your push
Then get them to place their wrists down and press on the other side
What do you asses after wrist strength?
Finger strength
Get them to place their hands out flat and press on their fingers
Then push against their index finger (abduction)
Then push against their pinky finger (abduction)
Then get them to turn their hands over and lift thumbs up, try to pull them down
What do you test after finger strength?
Biceps reflex
At the bottom of the biceps test with the tendon hammer
What do you test after the biceps reflex ?
Triceps reflex
Check at bottom of triceps muscle
What do you assess after triceps reflex?
Supinator reflex
Tap hammer onto fingers at supinator
What do you test after supinator reflex?
Light touch sensation
Get patient to close their eyes and lightly tap them with cotton wool on each dermatome, asking if them to say yes if they feel it, and if it is the same on both sides
What do you assess after light touch sensation?
Pin prick sensation
Repeat light touch with pinprick on each dermatome .Compare left to right. Get them to say yes each time
What do you assess after pinprick sensation?
Vibration
Use tuning fork and give them an example on chest what is will feel like
Test Distal Bony Prominence on finger and ask them to tell you when it stops vibrating
What do you do if the patient can’t feel the vibration at the DBP?
Asses more proximally until they can
What do you assess after Vibration?
Propioreception
Move patients thumb up and down and instruct them which one is which. Make sure to hold the finger at its base. Then get them to close their eyes and move their thumb up or down . Get them to tell you which way the thumb is move into
What do you assess after proprioreception? ( upper limb )
Finger to nose test
Get patient to touch nose then touch your outstretched finger. Repeat on both sides
What are you observing for with the finger to nose test?
Intention tremor ( cerebellar disease )
What do you test after the finger to nose test?
Rapid Alternating Movement
Place on hand on top of the other and rapidly flip it round
Testing for Dysdiadokinesia
What do you look for in a general inspection of the lower limb?
Symmetry
Wasting
Involuntary Movements
Fasciculations
Tremor
What do you assess after l.limb general inspection?
Gait
Ask if they can walk unaided
Get patient to cross arms and stand up unaided
Get patient to walk
What are you observing the gait for?
Speed
Symmetry
Balance
Arm Swing
What do you examine after gait?
Tandem gait
Get them to walk one foot in front of the other
What do you assess after tandem gait?
Walking on tip toes (Plantarflexion)
Walk on heels (Dorsiflexion )
What do you assess after all the gaits?
Romberg test
Get patient to stand still and place arms either side of them in case they wobble
What do you assess after Rombergs test?
Tone
Get patient to let leg go floppy
Leg roll ( at thigh )
Leg lift ( at knee)
What do you assess after tone?
Ankle clonus
Lift lower leg up
Move ankle in circle then push foot towards patients body
What do you assess after ankle clonus?
Strength
Get patient to lift leg up and push down
Get patient to push leg against the leg whilst you push up
Get patient to abduct their legs against your resistance and then addict against resistance
Get patient to bend thier leg up and push against your hand , which is below leg
Then get patient to bend leg and kick out against resistance
Ask patient to bring their toes towards themselves and push down
Then push feet down against your hand
Then push down on big toe and get them to resist
Then test ankle inversion
Then test ankle eversion
What do you test after strength?
Knee jerk reflex
Get patient to let legs go floppy and then tap patella ligament with tendon hammer. Support leg from beneath thigh whilst you do this
What do you do after the knee jerk reflex?
Ankle reflex
Put legs out to the side and relax.
Then tap the Achilles tendon
What do you test after the ankle jerk reflex?
Plantar reflex
Run blunt neurotip against sole of foot from bottom to top , toes should curl
What do you test after plantar reflex?
Light Touch Sensation
Get patient to close eyes
Use cotton wool
Use reference on sternal angle
Assess each dermatome
What do you assess after light touch?
Pinprick touch
Using neurotip
Close eyes
Check both sides
Do each dermatome
What do you do if neural sensation is reduced ?
Use neurotip to go up from toes upwards to check where sensation starts
What do you assess after pinprick test?
Vibration
Show vibration of sternal angle
Test with tuning fork of distal phalange
Ask them to tell you when it stops
What do you test after vibration ?
Proprioreception
Move their big toe up and down . Then get patient to close their eyes and tell you when you move it up or down
What do you test after proprioreception? (Lower limb)
Coordination
Get patient to put ankle on knee, then run it down their legs, then back to their knee in a circle.
Then do the same thing on the other side
What do you test after coordination?
Quick movement
Get patient to tap their feet against your hands as quickly as possible
