PERIPHERAL NERVOUS SYSTEM Flashcards
1
Q
PNS - WHAT MAKES UP A PNS EXAM?
A
- General inspection
- Gait
- Myotomes
- Tone
- Deep tendon reflexes
- UMNL Vs LMNL
2
Q
PNS - GENERAL INSPECTION - SCARS
A
- Scars: may provide clues regarding previous spinal, axillary or upper limb surgery.
3
Q
PNS - GENERAL INSPECTION - WASTING OF MUSCLES
A
- Wasting of muscles: suggestive of lower motor neuron lesions or disuse atrophy.
4
Q
PNS - GENERAL INSPECTION - TREMOR
A
- Tremor: there are several subtypes including resting tremor and intention tremor.
5
Q
PNS - GENERAL INSPECTION - FASICULATIONS
A
- Fasciculations: small, local, involuntary muscle contraction and relaxation which may be visible under the skin. Associated with lower motor neuron pathology (e.g. amyotrophic lateral sclerosis).
6
Q
PNS - GENERAL INSPECTION - MYOCLONUS
A
- Myoclonus: brief, involuntary, irregular twitching of a muscle or group of muscles. All individuals experience benign myoclonus on occasion (e.g. whilst falling asleep) however persistent widespread myoclonus is associated with several specific forms of epilepsy (e.g. juvenile myoclonic epilepsy).
7
Q
PNS - GENERAL INSPECTION - HYPOMIMIA
A
- Hypomimia: a reduced degree of facial expression associated with Parkinson’s disease.
8
Q
PNS - GAIT
A
- Gait and stance are reliant upon many factors: Vision, Sensation, Proprioception, Motor output.
- Unsteadiness on standing with the eyes open is common in cerebellar disorders – Cerebellar Ataxia
9
Q
PNS - CEREBELLAR ATAXIA
A
- Cerebellar dysfunction leads to a broad-based, unsteady (ataxic) gait, which usually makes tandem walking (walking heel to toe in a straight line) impossible
- Instability which only occurs, or is markedly worse, on eye closure is indicative of proprioceptive sensory loss, referred to as Sensory Ataxia
10
Q
PNS - ABNORMAL GAIT EXAMPLES
A
- Bilateral upper motor neuron damage causes a scissor-like gait due to spasticity. (Spasticity – incr muscle tone & spasm)
- Propulsive gait – a stooped, stiff posture with the head and neck bent forward
- Scissors gait – legs flexed slightly at the hips and knees like crouching, with the knees and thighs hitting or crossing in a scissors-like movement
- Spastic gait – a stiff, foot-dragging walk caused by a long muscle contraction on one side
- Steppage gait – foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking
- Waddling gait – a duck-like walk that may appear in childhood or later in life
11
Q
PNS - GAIT AND COORDINATION TESTS
A
- For cerebullum ataxia/Co-ordination impairment. Common in MS
- Rombergs sign/pronator drift – stand with feet togther and arms out in front for 30secs the repat with eyes closed. Or in supination, observe if patients pronate involuntaily. +Ve if Pt cannot remain balenced
- Finger-nose test – Pt touches nose then practintioners finger, which is moving left to rght & forward/backwards. +Ve if Pt over shoots and misses – issues with depth perception. False posative may by an optic injury.
- Heel/shin test
- Dysdiadochokinesis – Pt places palm ontop of palm in supination, then pronation, then repated again and again.
12
Q
PNS - MYOTOMES
A
- A group of muscles which is innervated by single spinal nerve root
- Ranked from 1 to 5. 1 being no visible contraction, 3 movement against gravity and 5 normal power.
- First ask Pt to do the movement first to check they can do the movement against gravity, tells you there are already a three.
13
Q
PNS - UPPER MYOTOMES
A
- C1-T1 myotomes for the upper body
- C1 Chin Tuck
- C2 Head back
- C3 - CSP SB
- C4 – Shoulder elevation
- C5 – Shoulder Abduction
- C6 – Elbow extension
- C7 - Elbow flexion
- C8 – Thumb extension
- T1 Finger Abduction, adduction.
14
Q
PNS - LOWER MYOTOMES
A
- L2-S2 myotomes for the lower body
- L2 Hip flexion, knee bent Pt drives knee to chest then down into
- L3 kick the door (Knee extension)
- L4 Dorsiflex and invert foot, resist Pt pulling back to neutral
- L5 - Big toes – Pt tries to extend
- S1 Plantar flex
- S2 Heel to bum (Knee flexion)
15
Q
PNS - ASSESSING TONE
A
- Tone – passive resistance to stretch, common in Parkinson’s and MS
- Wrist – flex/extend
- Elbow - flex/extend
- Shoulder – abduction, adduction
- Hips - ‘roll’
- Knee - flexion
- Tone is graded from 0 -4 (No response, Hypotonia, Normal response, Mild-moderate hypertonia, Severe hypertonia)
- Stiffness – compliance to deformation
16
Q
PNS - DEEP TENDON RELFEXES
A
- Biceps C5
- Brachioradialis C6
- Triceps C7
- Patella L4
- Achilles S1
- Use Jendrassik manoeuvre – smile/grit their teeth, grip hands and try to pull apart, distracts them from the reflex
17
Q
PNS - LOSS OF DEEP TENDON REFLEX IMPLICATION
A
- Peripheral neuropathies secondary to diabetes, alcohol abuse, or inflammation.
