SPARC UL LL Flashcards
Sensation of upper limb - 7-8 points
Deltoid regimental badge - axillary nerve / C5
Arm lateral - C5 + radial
Forearm lateral - C6 + musculocutaneous
Thumb - C6 + median
Middle finger - C7
Little finger - C8 + radial
Forearm median - C8 + cutaneous
Arm medial - T1
In fine touch, do not stroke
- Activates nociceptors and itch -> becomes testign for spinothalamic tract
Inspection of UL and LL
Both must be full inspection
- Why?
Wasted thighs + shoulder - proximal myopathy
Wasted fingers and distal muscles - distal myopathy
Upper limbs
Lower limbs
Upper back
Neck
Head
Initial additional manoeuvers
Pronator drift with finger adduction
Wrist drop
Grip myotonia - strong sustained grip for 3 seconds then release
Power of UL
Shoulder abduction
Shoulder adduction - kiap
Elbow flexion and extension - 90 degree, stabilise elbow
Wrist flexion and extension -
No need like for like, just use hands
Pitfall of glove and stocking numbness
Axonal
Length dependent
Up to the knee and glove area
Additional manoeuvers for lower limbs
Dorsiflexion - foot drop
One manoeuver only
Tone examination of UL
Passive elbow flexion and extension - slow then fast, full range
Passive wrist flexion and extension - whole UL hanging, slow then fast
Pronate supinate - fast supinate, slow pronate
Tone of LL
Roll legs
Move legs slowly then fast for rigidity
- If legs go off the bed - spasticity
- if legs draggy - flaccid
Clonus
Do if DTR 2+
Sustained 5+
Present but not sustained 4+
Reflexes of UL and LL
Elbow flexed 90 degree and relaxed
- Biceps: Tap with finger support
- Triceps: Tap without support
- Brachioradialis: support thumb with thumb, tap with finger support
LL
Lift knee and relax to tap knee
Bend knee to test ankle
Then test clonus together
Plantar reflexes
Stroke for 3-5 seconds from sole to 1st MTPJ
- Babinski negative: S1 loops back to S1 - downgoing
- Babinski positive: slow extension - spinal cord disorder disinhibition, S1 stimulus activates L4, L5
- Withdrawal: fast extension
Use the term: positive plantars or negative plantars
Forgo use of Babinski term
Power of LL
Patient active lift whole LL up - can also see downdrift and ataxia if present
Then only test power hip flexion
Hip extension - push leg down against hand
Hip abduction/adduction
Turn lateral side
Press lateral surface of gluteus region for gluteus minimus
Press down over lateral thigh
Internal/external rotation
- Lift leg up, bend knee 90 degree, passive internal/external rotate then ask to push against resistance
Knee as usual
Ankle dorsiflexion and eversion concurrently
Ankle plantarflexion and inversion concurrently
Toe flexion and extension
Sensation for LL
Perfect reference point: forehead - but hygiene issue
Then test sternum - if equal, to use it as indirect reference point
Anterior thigh - L2 + femoral
Medial aspect of knee - L3 + femoral
Medial malleoli - L4 + saphenous branch of femoral nerve
distal lateral malleoli - L5 + superficial peroneal
1st dorsal webspace - L5 + deep peroneal
lateral side of foot - S1 + tibial nerve
Try to avoid soles - cleanliness issue
Peripheral neuropathy
Distal to proximal x2 (medial, lateral) to obtain level of sensation
Heel shin dysmetria
Jerky or wavy heel from knee to shin
Not related to hitting toe against finger - most ppl will likely miss as it is too difficult
Romberg test and walking patient
Sit patient to side, check no truncal ataxia first
Then stand patient
Both arms hugging
Eeys closed
Romberg more towards tabes dorsalis - sensory ataxia
- Dysequilibium on eyes closed
Do not perform in cerebellar ataxia - patient will definitely fall
