PNS Flashcards
UMN signs
Increased tone, clonus
Weak : arm extensors, leg flexors
Brisk reflexes
Extensor/babinski plantars
BG lesions = Parkinsonism
Caudate nuc/putamen = ballism, tics
LMN signs
MW fasiculation N or reduced tone, no clonus Focal ie nerve distrib weakness Reduced/absent reflexes Normal ie flexor plantars
Lower limb observe
Assymetry/deformity prox and distal also wasting, deformity, hypertrophy, fasiculation, invol mvt
STAND
Balance stand feet together
Close eyes ROMBERG ie sensory ataxia +ve = fall
Push pull test
Gait = walk 10m, heel toe, then each! PD - tremor/shuffling L5, common peroneal nerve = Foot drop - slapping, inc tiptoes Cerebellar = wide based, ataxic Myopathy = waddle, +ve trendelenberg CVD/hydrocephalus = apraxia
Lower limb muscles
Assymetry/deformity prox and distal
Bulk - wasting/hypertrophy MEASURE QUADS
?fasciculation ie flick / invol mvts
Tremor = invol oscillatory mvt Frequency Amplitude Position Body part
N = fine, fast ie Th, caffine, etoh
PD = slow, coarse, pill rolling
Increase: rest, UL
Head = dystonia
Cerebellar = intention
Neurop ie CMT
Drugs ie valproate
Other abn mvts: chorea, athetosis
TONE
Resistance to passive mvt
Test: slow and fast, unpredictable, full ROM
FIRST ROLL LEGS/LIFT AND DROP
PATELLAR ie briskly push down ie clonus
ANKLE CLONUS - both at 90 support, briskly dorsiflect and evert foot, maintain
LMN reduced
UMN increased = SPASTICITY = velocity dependent ie faster = catch beginning and end
CLONUS = rhythmic contractions sustained in UMN 6+ beats
PD = rigidity = sustained throughout ie lead pipe +- tremor = cogwheeling MD/MYOTONIA = stiffness
REFLEXES before POWER
Monosynapic ie stretch receptor - efferent to sc then afferent to muscle
Strike thumb - biceps/supinator
Hold wrist - elbow
Finger jerk - hold hand tap up
C5/6 biceps and supinator
C6/7 triceps
C8 finger
Knee l3/4
Ankle s1
PLANTARS s1/2 n=down
Reflex patterns
UMN increased
Decreased
LMN ie radiculopathy
Holmes Adie
POWER
MRC 5 n against resistance and gravity 4 resistance = weaker 3 gravity 2 w/o gravity 1 flicker 0 nil
SLR ie hip flex
Knee f e
Ankles - dorsiflect/planters
Power areas
Shoulder abd deltoid C5 Elbow flex C5/6 Elbow ext C7 Wrist ext C6 Finger flex C8 Finger ext C7 Finger abd T1
Hip flex L1/2 Hip ext L5/S1 Knee flex S1 Knee ext L3/4 Ankle dorsi L4/5 Ankle plantar S1/2
Power patter
Myopathy = proximal mw Neuropathy = distal ie glove/stocking MG = fatiguability
Paresis - partial Plegia - complete Monoplegia - single limb Hemiplegia - one half body Paraplegia - legs Tetraplegic - all limbs
COORDINATION
Finger nose ie past pointing, intention tremor SHOULD BE FAST
Dysdiadochokinesia ie palm ?clumsy/slow eg dyssnyergia
Heel - shin
?foot tap
If ETOH or midline c only abn may be GAIT!
APRAXIA ie cortical = imaginary tasks/copy mvts ie non-dominant parietal or frontal = constructional
ABDO REFLEXES ie q stroke med
SENSATION
Light touch - cotton wool IREG!
Pain - neurotip
Temp - cold metal
VIBRATION - 128 hz move distal ie from big toe/DIPJ and stop!
PROPRIOCEPTION - same ie direction big toe look first
COMPARE
? VISUAL INATTENTION - touch both
STEREGNOSIS objects
L2 side of hip L3 med knee L4 med calf L5 lat calf + foot dorsum S1 lat foot m + sole ?S2 underside of calf
Sensation patterns
VIBRATION PROPRIOCEPTION - dorsal post columns, deccusate at medulla = FAST LARGE MYELINATED
PAIN TEMP - PNs spinothalamic tracts, thalamus, parietal, deccusate few segs above = SLOW SMALL
LENGTH DEPENDENT PN ie glove and stocking LL>UL
DEMYELINATING PN ie UL FIRST
GB ie LARGE FIBRE ie vib and prop - romberg, pseudoa??
DM / HIV SMALL FIBRE ie pain, temp
Upper limb OBSERVE
Prox/distal
Asymmetry
?deformity ie clawing
TREMOR
PRONATOR DRIFT!! = spasticity/UMN
MW/hypertrophy feel bulk ie then at
Fasciculation - flick skin over muscle
Invol mvt
Upper Limb TONE
Hold as if shaking hand, hold elbow, move all joints
Vary speed/direction
Compare sides
?WRIST CLONUS
?spacitcity v rigidity
