Peripheral Nerves physical exam Flashcards
cervical spinal nerves
8
thoracic spinal nerves
12
lumbar spinal nerves
5
sacral spinal nerves
5
coccygeal spinal nerve
1
of each spinal nerve, what contains the motor fibers
anterior (ventral) root
of each spinal nerve, what contains the sensory fibers
posterior (dorsal) root
spinal nerve is made of
anterior and posterior roots
Spinal nerve fibers commingle with similar fibers from other levels in plexuses outside the cord, from which _______ nerves emerge
peripheral
migraine, tension, cluster and trigeminal cephalagias
headaches
what to assess when someone presents with HA
location, duration, any associated symptoms (double vision, vision changes, weakness, loss of sensation)
what can signal meningitis
fever, HA, stiff neck
previous ear, sinus, throat, URI infection
vertigo 2 main causes
peripheral (ear)
central (brain)
“pins and needles”
paresthesia
burning pain
neuropathies (diabetic)
_____ is associated with UMN damage
hypertonia
____ is associated with hypotonia
LMN damage
grade for muscle strength with active movement against gravity
3
grade for muscle strength with active movement against gravity AND some resistance
4
spinal n. and muscle associated with shoulder abduction
C5-deltoid
spinal n. and muscles associated with shoulder adduction
C7- pectoralis major, lattisimus dorsi
spinal nerves and muscles associated with elbow flexion
C5, C6- biceps and bracioradialis
spinal nerves and muscle associated with elbow extension
C6, C7, C8- triceps
spinal nerves and muscles associated with wrist flexion
C6, C7, C8- flexor carpi radialis, flexor carpi ulnaris, palmaris longus
spinal nerves and muscles associated with wrist extension
C6, C7, C8, radial n.- extensor carpi radialis longus and brevis
spinal nerves involved in grip strength
C7, C8, T1
spinal nerves and muscles involved with finger abduction
C8, T1, ulnar n.–dorsal interossei
spinal nerve and muscle involved in finger adduction
T1–palmar interossei
spinal nerves involved with opposition of the thumb
C8, T1, median n.
spinal nerves and muscles involved with hip abduction
L4, L5, S1–gluteus medius and minimus
spinal nerves and muscles involved in hip adduction
L2, L3, L4–adductors
spinal nerves and muscle involved in hip flexion
L2, L3, L4—iliopsoas
spinal nerve and muscle involved in hip extension
S1- gluteus maximus
spinal nerves and muscle involved in knee flexion
L4, L5, S1, S2—hamstrings
spinal nerves and muscle involved in knee extension
L2, L3, L4—-quadriceps
spinal nerves and muscle involved in foot dorsiflexion
L4, L5—tibialis anterior
spinal nerve and muscles involved in plantarflexion
S1—gastrocnemius, soleus
when testing for sharp vs dull, and light touch, what spinal nerve is tested on tops of shoulders
C4
when testing for sharp vs dull, and light touch, what spinal nerve is tested on the medial and lateral aspects of forearm
C6,T1
when testing for sharp vs dull, and light touch, what spinal nerve is tested on the thumbs and pinkie fingers
C6, C8
when testing for sharp vs dull, and light touch, what spinal nerve is tested on the front of the thighs
L2
when testing for sharp vs dull, and light touch, what spinal nerve is tested on the medial and lateral aspects of both legs
L4, L5
when testing for sharp vs dull, and light touch, what spinal nerve is tested on the little toes
S1
____ sense is often the first sensation lost in peripheral neuropathy
vibration
joint position sense
proprioception
___ and ____ can be seen in multiple sclerosis, B12 deficiency, diabetic neuropathy, and others
loss of position sense and loss of vibration
ability to identify object by feeling it
Stereognosis
ability to identify numbers when writing it on patients hand
graphesthesia
lesions of ____ cortex are involved with parietal lobe
sensory
lesions of _____ cortex are involved with frontal lobe
motor
grade for average/normal muscle stretch reflex
2
____ are seen in CNS lesions of the descending corticospinal tract
hyperactive reflexes
weakness, spasticity, or a positive Babinski sign
upper motor neuron findings
___ or ____ reflexes occur in lesions of the spinal nerve roots, spinal nerves, plexuses, or peripheral nerves
hypoactive or absent
weakness, atrophy, or fasciculations
lower motor neuron findings
_____ initiates voluntary movement (located in the brain)
UMN
____ carries out the voluntary movement (located in the spinal cord)
LMN
spinal nerves involved with biceps reflex
C5, C6
spinal nerves involved with triceps reflex
C6, C7
spinal nerves involved in brachioradialis reflex
C5, C6
spinal nerves involved with the quadriceps (patellar) reflex
L2, L3, L4
spinal nerves involved with the Achilles (ankle) reflex
S1
present if rhythmic oscillations between dorsiflexion and plantar flexion are felt or seen; points to CNS disease
clonus
spinal nerves involved with plantar reflex
L5, S1
a positive ____ response is when there is dorsiflexion when doing plantar response and means there is a CNS lesion affecting what tract
Babinski response; corticospinal tract
assess for meningeal inflammation
Technique:
Flex the patient’s neck, watch the hips and knees in reaction to your maneuver.
Normally they should stay relaxed/motionless.
If the hips and knees flex it is a positive sign
Brudzinski sign
assess for meningeal inflammation
Technique:
Flex patient’s leg at hip and knee, and then slowly extend the leg and straighten the knee.
Pain and increased resistance to knee extension are a positive sign
Kernig sign
assess for lumbosacral radiculopathy
- Technique:
Place patient in a supine position.
Raise the patient’s relaxed and straightened leg, flexing the thigh at the hip.
Assess the degree of elevation at which pain occurs, the quality and distribution of pain.
Pain radiating in into the ipsilateral leg is + finding
Straight-leg raise
Assesses for metabolic encephalopathy (like in kidney disease
Technique:
Ask patient to “stop traffic” by extending both arms, with hands cocked up and fingers spread.
Watch for 1 to 2 minutes.
Sudden, brief, nonrhythmic flexion of hands and fingers followed by recovery indicates ____
Asterixis
