Periphere Neurological Examination Flashcards
What do you look for in Inspection of peripheral neurological Exainsation?
SWIFT
- Scars
- Wasting
- Involuntary movements
- Fasciculations
- Tremor
- Specific signs e.g neurofibromas
- Face (hypomimia, ptosis, ophthalmoplegia)
What things could you notice around the patients bedside in a peripheral neurological examination?
- Walking aid
- Wheelchair
- Catheter bag
How do you test the pronator drift?
What does in indicate?
Let patient stretch out arms supine
See if one arrm drops / pronates
Indicates UMN lesion on the contralateral side
How can you differnetiate Hypertonia?
In
- Spacticity (Velocoty dependant = the faster you move the harder)
- Rigidity (not velocoty dependant)
- e.g. parkinsons
Which Myotomes do you test when testing for power of the shoulder
Chicken wings
- Adduction = C6/7
- Abduction = C5
Which Nerve routes do you test when testing for power of the elbow?
Boxer Position
Elbow flexion (C5/6)
•Elbow extension (C7)
Which nerve routes do you test when testing for writst power?
- Wrist flexion (C6/7)
- Wrist extension (C6)
Which Nerve routes do you test when testing for the power in fingers?
Fingers
- Abduction (T1)
- Adduction (C8/t1)
What is the Muscle Power Scale (MPS)?
Scale of classifiying muscle power
Which reflexes do you test in an upper limb exam?
Which nerve route do they test?
Supinator reflex (C5/6)
Biceps reflex (C5/6)
Triceps reflex (C6/7)
What does hypo/hyperreflexia indicate?
Hyper = UMN lesion
Hypo = LMN lesion
Which dermatomes do you test in an Upper limb exam?
How do you test vibration sensation in an Upper limb exam?
128 Hz tuning fork
- hold on most distal joint (humans interphalangeal joint of thumb)
- ask w exes closed when they can feel vibration + when does it stop
- if abnormal move closer until can feel
What is the Rapid alternating movement test?
Dysdiodokinesia - cerebellar pathology
How do you test coordination in the upper limb?
- Finger - Nose test
- Past pointing
- Intention Tremor
- Cerebellar Pathology
- Rapid alternating movement test
- Cerebellar Pathology
What are signs of Cerebellar Pathology?
- Dysdiodokinesia
- Ataxia
- Nystagmus
- Intention Tremor
- Slurred Speech (dysarthria)
- Hypotonia/Heel-shin test
What additional examinations could you reccomend on completion of an upper limb neurological examination?
- Full neurological examination (upper/lower limbs & cranial nerves)
- Mini mental examination
- Assessment of gait and balance
How would you test the gait in a lower limb neurological examinaiton?
Let patient walk
Turn around
Come back with
- Heel toe
- Tip toe and
- Heel walk
What would you look for in the gait assessmeent of a patient?
- •Speed
- •Symmetry
- •Stance
- •Stability
- •Arm swing
- •Steps
- •Turning
*
What is an Ataxic gait?
What does it indicate?
- Incoordination
- Swaying of body
- and poor balance
Might be due to
- Cerebellar ataxia
- Sensory ataxia
What are the characteristics of an parkisonian gait?
- Bradikinesia
- Lean forward
- Reduced arm movement
- Feet barely lifted from ground
What does an high stepping gait indicate?
peroneal nerve palsy and L5 radiculopathy
How do you conduct the Rhomberg’s test?
Balance requires 2 out of the following 3:
- proprioception
- vestibular function
- vision
•Positive Romberg’s - Patient is more unsteady w eyes closed indicates :
- sensory ataxia
If there is no difference with eyes closed/open indicateds
- Cerebellar ataxia (negative rhombers)
Which myotomes do you test whith Hip power?
- Hip flexion (L1/2)
- Hip extension (L5/S1)
- +/- Abduction (L2/3)
+/- Adduction (L4/5)
