PRACTICAL: Motor System EXAMINATION Flashcards
Motor System Examination POINTS
🧠⚡The:ABCDEFG ⚡
- Tone Assessment
- Attitude of the limb
- Bulk of the muscle
- CoorDination
- Examination of POWER
- reFlexes
- Gait
Attitude
Define
Position of the limb which it adopts when the patient is in RESTING POSITION
Attitude of UPPER LIMB IN HEMIPLAGIA
Lower LIMB Attitude in HEMIPLEGIA
⭐ EXTENDED at HIP and Knee
⭐ Externally Rotated at HIP
⭐ FOOT INVERTED
⭐ PLANTAR FLEXED
Erb’s Paralysis
PARAPLEGIA ATTITUDE
PLEGIAs
Wasting is considered if
⭐ Reduction in Dominant Extremity
⭐ Reduction in Non-Dominant Extremity
Wasting is considered if
⭐ Reduction in Dominant Extremity
> 1cm
⭐ Reduction in Non-Dominant Extremity
> 2cm
Measurements of circumference is done at
🧠⚡Paties: ₹18 ⚡
⭐ 10cm below OLECRONON
⭐ 10cm above MEDIAL EPICONDYLE of HUMERUS
⭐ 18cm ABOVE the PATELLA
⭐ 10cm BELOW the TIBIAL TUBEROSITY
Pseudo-HYPERTROPHY
Cause?
6 CAUSES
⭐ ⭐ INCREASED FAT IN MUSCLE
CAUSES:
1. DUCHENE’S MUSCULAR DYSTROPHY
2. BECKER’S MUSCULAR DYSTROPHY
3. HOFFMAN DISEASE
4. KOCHER-DEBRE-SEMELAIGNE Syndrome
5. MYOTONIA CONGENITA: THOMSEN’S DISEASE
6. STORAGE DISORDERS
7. Juvenile SMA Type 2: KUGELBERG WELANDER DISEASE
Hypothyroidism
➕
Pseudo-HYPERTROPHY
In Adults?
🧠⚡ MAN is adult⚡
In Children?
🧠⚡KOCH in malyalam = Child ⚡
Kocher Syndrome
Synonyms
⭐ Kocher-Debre-Semelaigne Syndrome
⭐ Infantile HERCULES Syndrome
True MUSCULAR HYPERTROPHY
Exercise
Localised MUSCLE SWELLING
HAMo TRC
⭐ HEMORRHAGE in the muscle
⭐ MYOSITIS OSSIFICANS
⭐ ABSCESS
⭐ TUMOR
⭐ RUPTURE of Muscle
⭐ CYST (CYSTICERCOSIS)
Generalized MUSCLE WASTING
Seen in
🧠⚡MAT²CH- Aids ⚡
- Malignancy
- Cachexia
- TB
- Thyrotoxicosis
- Addison’s Disease
- HIV/AIDS
PROXIMAL MUSCLE WASTING
Seen in
⭐ MOTOR NEURON DISEASE
⭐ MUSCULAR DYSTROPHY
⭐ INFLAMMATORY MYOPATHIES: Polymyositis, etc
⭐ PLEXOPATHIES
⭐ AXILLARY NEUROPATHY (LARGE FIBER NEUROPATHY)
Inflammatory MYOPATHIES
⭐ Polymyositis
⭐ Dermatomyositis
⭐ Inclusion Body MYOSITIS
⭐ Autoimmune NECROTIZING MYOPATHIES (AINM)
DISTAL MUSCLE WASTING
Seen in:
⭐ ANTERIOR HORN CELL DISEASE: Polio, MND
⭐ Syringomyelia, Intramedullary tumours
⭐ Small Fibe Peripheral POLYNEUROPATHY
⭐ Myotonic DYSTROPHY
⭐ Plexopathies: Lower Brachial Plexus injuries
⭐ Arthritis: Rheumatoid
⭐ Disuse ATROPHY
HAND MUSCLE WASTING
SPLIT HAND SIGN
Seen in
AMYOTROPIC LATERAL SCLEROSIS
TONE
Define
⭐ RESISTANCE FELT DURING PASSIVE JOINT MOVEMENT
⭐ Partial state of Contraction of the muscle at REST which is demonstrated by RESISTAMCE OFFERED BY MUSCLE TO Passive Movement across the joint
TONE assessment is done in
⭐ UPPER LIMB (Wrist and Elbow joint)
⭐ LOWER LIMB (KNEE and ANKLE joint)
⭐ TONE of BICEPS is assessed during
⭐ TONE of TRICEPS is assessed during
⭐ TONE of BICEPS is assessed during
✨ EXTENSION
⭐ TONE of TRICEPS is assessed during
✨ FLEXION
Tone is dependent on
VELOCITY-DEPENDENT
Tone of the muscle is DUE TO:
⭐ Integrity of REFLEX ARC
⭐ LOW FREQUENCY and ASYNCHRONOUS Discharge of GAMMA- MOTOR NEURONS
⭐ Rate of GAMMA-MOTOR NEURON Discharge is LOW
⭐ Rate of GAMMA-MOTOR NEURON Discharge is HIGH
⭐ HYPOTONIC
⭐ HYPERTONIC
TONE OF HIP is checked by
Rolling the THIGH Side-to-side
Erb’s PARALYSIS
🧠⚡ADIR: Prone ➡️ POSITION OF LIMBS ⚡
Policeman Hand Deformity
Adduction ➕ INTERNAL ROTATION ➕ Pronation
TONE OF KNEE joint is checked by
METHOD1:
Place hands behind the patient’s knee and lift the leg in a sudden motion
⬇️
Observe if HEEL Drags along the BED
⬇️
Represents NORMAL TONE
METHOD 2:
DO FLEXION AND EXTENSION OF THE KNEE JOINT
HYPERTONIA OF KNEE is checked by
Foot does not make contact with the BED after the maneuver
TONE OF WRIST is checked by
Do Flexion and Extension at WRIST JOINT
⬇️
Do Circular Motion of the WRIST
TONE OF ELBOW JOINT is checked by
⭐ Flexion and Extension
⭐ Supination and Pronation of Forearm
TONE OF ARM is checked by
⭐ Flexion and Extension of Shoulder Joint
⭐ Adduction and Abduction of Shoulder
HYPOTONIA
Causes of HYPOTONIA
- LMN Lesion
-motor side of reflex arc affected
-sensory side
-combined motor ➕ sensory
-lesion of Muscles
-lesion of NMJ - Stage of NEURONAL SHOCK in UMN lesion
- Cerebellar lesions
- Chorea
- Periodic Paralysis
- REM SLEEP
- BZD overdose
- Neuromuscular blockers
- HYPOTHYROIDISM
- DOWN Syndrome
- HYPERMAGNESEMIA
Types of HYPERTONIA
SPASTICITY vs RIGIDITY
🧠⚡ Rigidity has Extra R⚡
🧠⚡ Gamma motor excess common for both ⚡
Causes of SPASTICITY
Causes of HYPERTONIA
- SPASTICITY
- Rigidity
- TETANUS
- SEIZURES (TONIC PHASE)
- TETANY
- CATATONIA
- PARATONIA
-Geganhalten
-Mitgehen - Strychnine poisoning
Fasiculations vs FIBRILLATION
Fasiculations seen in : Motor neuron or Axonal DEGENERATION
FIBRILLATION : Anterior Horn cell diseasea
Causes of Fasiculations
- Amyotrophic Lateral Sclerosis
- SMA
- Post POLIO Syndrome
- HyperThyroidism
- Organo phosphorus poisoning
- Atropine, Lithium
- Mercury
- Benign Fasiculations
Myotonia
Meaning
Muscle contraction continues beyond the period of time required for a particular movement, there is FAILURE of Normal Muscle Relaxation
✨ CONTINUED, INVOLUNTARY MUSCLE CONTRACTION EVEN AFTER CESSATION OF VOLUNTARY EFFORTS
MYOTONIA is Best seen in Muscles of
Face : continued smiling
Hand : Delay in relaxation of grip
Myokymia
Seen in
Continuous RIPPLING/VERMICULAR movement of a group of muscle fibers that can be seen in NEUROPATHIES
✨ GBS
✨ Plexopathies
✨ Isaac Syndrome
Cause of MYOTONIA
- Myotonic Dystrophy Type 1 and 2
- MYOTONIA Congenita
- Paramyotonia Congenita
- Hyperkalemic Periodic Paralysis
Clasp Knife Phenomena
Increased TONE only during the INITIAL PHASE
⬇️
After a point
⬇️
SUDDEN LOSS OF TONE
Muscles involved in SPASTICITY
Antigravity MUSCLES
⭐ Upper Limb: FLEXORS
⭐ Lower Limb: EXTENSORS
SUPINATOR CATCH seen in
SPASTICITY
Supination-Pronation of the forearm will reveal it
Klumpke’s PARALYSIS
🧠⚡FESs High ⚡
🧠⚡ Klump = clamp = Holding tree⚡
Elbow Flexed ➕ Supinated Forearm
➕ U/L HORNER SYNDROME
Erb’s Palsy root value
CATATONIA
Altered tone of the muscle in
⭐ B/L FRONTAL LOBE DYSFUNCTION
⭐ DIFFUSE CEREBELLAR DISORDERS
Oppositional CATATONIA
(OR)
Gegenhalten
Subject involuntarily RESIST PASSIVE MOVEMENTS
FACILITATORY PARATONIA
(OR)
MITGEHEN
Subject involuntarily assists PASSIVE MOVEMENT
Qualitative Assessment of POWER or WEAKNESS by
MRC Grading
MRC Grading of POWER of Muscle
Grade 0- No contraction
Grade 1- Flicker or trace of contraction
Grade 2- Active movement, with gravity eliminated
Grade 3- Active movement against gravity
Grade 4- Active movement against gravity and resistance
Grade 5- Normal power
Grades 4- : movement against slight resistance
Grades 4 :movement against moderate resistance
Grades 4+ :movement against Strong resistance
