Unit 2 Info Flashcards
Dermatome: posterior aspect of the shoulders
C4
Primary sensory modality is not in working order deficit referred to as
Analgesia
Anesthesia
Dermatome: lateral aspect of the upper arms
C5
Dermatome: medial aspect of the lower arms
T1
Dermatome: tip of the thumb
C6
Dermatome: tip of the middle finger
C7
Dermatome: tip of the pinky finger
C8
Sensory distribution: AXILLARY NERVE
LATERAL DELTOID
Sensory distribution: MUSCULOCUTANEOUS
LATERAL FOREARM
Sensory distribution: RADIAL NERVE
WEB SPACE, THUMB AND INDEX FINGER
Sensory distribution: ULNAR NERVE
DISTAL ULNAR ASPECT OF 5TH DIGIT
Sensory distribution: MEDIAN NERVE
DISTAL RADIAL ASPECT OF PALM AND DIGITS 1-3
Superficial sensory exams test for which modalities and what is used to test each modality?
Pain (sharp, pin prick)
Temperature (test tubes with hot or cold water)
Light touch (cotton swab, small brush)
Neuro-pathway for light touch would be thru the __________ of the cord to the thalamus.
anteriorlateral columns (anterior spinothalamic tract)
Deficits to light touch in dermatomal pattern may indicate __________ or ____________.
Nerve Root compression
Peripheral nerve lesions
Pain examination finds problems in the _________ tract.
lateral spinothalamic
Deficits to pain in dermatomal pattern may indicate _____________ or ___________.
Nerve Root compression
Peripheral nerve lesions
Alganesthesia/analgesia:
Hypalgesia:
Hyperalgesia:
areas insensitive to pain
decreased sensation
increased sensitivity
Pallanathesia
Loss of vibratory sense
Tractus ________ for upper extremity
Tractus ________ for lower extremity
Cuneatus
Gracilis
Temperature examination:
Cold: ________ degrees F
Hot: ________ degrees F
41-50
104-113
Compression of dorsal nerve root signs/symptoms
Numbness and tingling are most common
Loss of vibration or position sense
Hyporeflexia with no muscle atrophy- No sensory input of stretch, but muscle can shorten and work normally
Compression of the anterior nerve root (motor) signs/symptoms
Muscle weakness
Loss of DTR – Muscle not responding, could have atrophy
No pathologic reflexes are present
Vasomotor changes due to autonomic nervous system being affected
Causes of nerve root compression
Disc herniation Degenerative joint disease Recent trauma Inflammatory changes Tumors
Strength testing 0/5
Complete paralysis, 0% of normal movement
No evidence of contraction
Strength testing 1/5
A twitch of the muscle, trace, 0-10% of movement
Dr. can feel muscle action but no movement seen
Strength testing 2/5
Moderate to severe paresis, active movement is available when gravity eliminated
11-25% of normal movement
Patient lay on side and move joint through full range without gravity
Strength testing 3/5
Moderate paresis, active movement against gravity
26-50% of normal movement
Complete range of motion against gravity
Strength testing 4/5
Mild paresis, active movement against gravity andmild resistance
51-74% of normal movement
Usually resistance of two fingers
Strength testing 5/5
Normal strength
76-100% of normal movement
Muscle tests for C5
DELTOID, BICEPS
Muscle tests for C6
BICEPS, WRIST EXTENSORS
Muscle tests for C7
WRIST FLEXORS, FINGER EXT
Decreased muscle tone indicates what kind of lesion?
LMNL
Increased muscle tone indicates what kind of lesion?
UMNL
Spasticity
increased muscular resistance felt by the examiner during quick joint movement which quickly fades away aka “clasped knife”
Spasticity is associated with ______ or _______ lesions (_MNL).
cortical
pyramidal
(UMNL)
Rigidity
involuntary muscular resitance felt when moving a resting joint and persists as the joint is moved through its entire range of motion. Aka
“gooseneck” rigidity, like bending a microphone holder
Rigidity is consistent with _________ pathways related to muscle spindle mechanism interference from diseased __________ structures (_MNL)
extrapyramidal
extrapyramidal
UMNL
Hypotonia is usually indicative of neurologic issues at the level of the ___________ (_MNL).
reflex arc
LMNL
Neural shock may occur following acute severe ________ motor neuron damage in the brain or spinal cord. Unique because suddenly occurring _______ first causes only _______ type symptoms
upper
UMNL
peripheral
Deficit Phenomenon
Loss of normal neurological function.Reduced muscle tone, muscle stretch reflexes, muscle strength, volume, (LMNL).
Release Phenomena
Exaggerations or perversions of normal neurological function due to a loss of cortical inhibition. Hyper-reflexia, hypertonia, and pathologic reflexes.
Biceps Reflex nerve supply
C5
Musculocutaneous
Nerves tested in the Brachioradialis Reflex
C6
Radial
Nerves tested in the Triceps Reflex
C7
Radial
Nerves tested in the Finger flexion reflex
C8
Median/ulnar
C5 Reflex
Biceps Reflex, Musculocutaneous
C6 Reflex
Brachioradialis Reflex, Radial
C7 Reflex
Triceps Reflex, Radial
C8 Reflex
Finger Flexion Reflex, Median/ulnar
Musculocutaneous Reflex
Biceps Reflex, C5
Median/ulnar Reflex
Finger flexion Reflex, C8
Radial Reflex
Brachioradialis Reflex, C6
Triceps Reflex, C7
Reflex Grading System 0= 1= 2= 3= 4=
0 = Absent 1 = hypoactive 2 = normal 3 = hyperactive 4 = hyperactive with sustained or transient clonus-specify
Superficial reflexes are graded as ________.
Either present or absent
Gag Reflex
Segmental/peripheral innervation:
Method:
Normal:
Segmental/peripheral innervation: CN IX, X
Method: Touch posterior tongue or back of throat
Normal: Gag and elevation of soft palate, constriction ofpharyngeal muscles
Corneal blink reflex
Segmental/peripheral innervation
Method:
Normal finding:
Segmental/peripheral innervation CN V, VII
Method: Touch cornea with cotton wisp
Normal finding: Blinking of eyes
Epigastric reflex Segmental innervation Peripheral nerve Method Normal finding
Segmental innervation (T5-T7)
Peripheral nerve (intercostal)
Method: Stimulate from sternum to umbilicus
Normal finding: Contraction of upper ab muscles, move umbilicus upward
Upper Abdominal Reflex Segmental innervation Peripheral innervation Method Normal finding
Segmental innervation (T7-T9) Peripheral innervation (intercostal) Method: Stimulate upper abs down and out, out to in Normal finding: Contraction of the upper abs, moves umbilicus upand out
Middle Abdominal reflex Segmental innervation Peripheral innervation Method Normal finding
Segmental innervation (T9-T11)
Peripheral innervation (intercostal)
Method: Stimulate skin from level of umbilicus out to in and vertical
Normal finding: Contraction of middle abs moving umbilicus laterally
Lower Abdominal Reflex Segmental innervation Peripheral innervation Method Normal findings
Segmental innervation (T11-T12) Peripheral innervation (intercostal, iliohypogastric, ilioinguinal) Method Stimulate the skin of lower abs from out to in and up to down Normal findings Contraction of lower abs moving umbilicus down and out
Cremasteric reflex Segmental innervation Peripheral innervation Method Normal findings May not be seen in
Segmental innervation (L1-L2)
Peripheral innervation (ilioinguinal, genitofemoral)
Method: Stroke inner thigh from superior to inferior direction
Normal findings: Ipsilateral elevation of the testicle
May not be seen in: elderly or hydrocele and varicocele
Gluteal Reflex Segmental innervation Peripheral innervation Method Normal finding
Segmental innervation (L4-S2)
Peripheral innervation (inferior gluteal)
Method: Stroke skin over glute max
Normal finding: contraction of gluteal muscles
Plantar Reflex Segmental innervation Peripheral innervation Method Normal Abnormal
Segmental innervation (L4-S2)
Peripheral innervation (tibial)
Method: Stroke plantar foot from heel to metatarsals to big toe
Normal: plantar flexion of toes and foot
Abnormal: dorsiflexion of great toe and flairing of the other toes
Anal Reflex (wink) Segmental innervation Peripheral innervation Method Normal finding
Segmental innervation (S2-S5) Peripheral innervation (hemorrhoidal) Method: Stroke skin of perianal area Normal finding: Contraction of external sphincter
CN IX, X Reflex
Gag reflex
CN V, VII reflex
Corneal blink reflex
T5-T7 intercostal nerve reflex
Epigastric reflex
T7-T9 intercostal nerve reflex
Upper abdominal reflex
T9-T11 intercostal nerve reflex
Middle abdominal reflex
T11-T12 intercostal/iliohypogastric/ilioinguinal reflex
Lower abdominal reflex
L1-L2 or ilioinguinal/genitofemoral reflex
Cremasteric reflex
L4-S2 or inferior gluteal reflex
Gluteal reflex
L4-S2 or tibial reflex
Plantar reflex
S2-S5or hemorrhoidal reflex
Anal reflex (wink)
The primitive responses seen with reflexes are pathological if
found in _______, but may be normal in _______ up to about _________ of age (or even up to _______ for certain reflexes, such as Babinski’s sign).
Adults
Infants up to 6 months of age
2 years
Hoffman Sign
Method
Positive sign
Lesion location
Method: Sharp forcible flick of thumb against patient’s middle finger
Positive sign: Flexion of fingers and adduction of thumb
Lesion location: Segmental (above C5 in corticospinal tract)
Tromner Sign
Method
Positive sign
Lesion location
Method: Tap the volmar surface of the middle finger
Positive sign: Flexion of fingers and adduction of the thumb
Lesion location: above C5 corticospinal tract
Rossolimo Sign
Method
Positive sign
Lesion Location
Method: Tap the ball of the foot or tap the tips of the toes
Positive sign: Plantar flexion of the toes
Lesion Location: Corticospinal tract
Babinski Sign Method Normal Abnormal Lesion location
Method: Stroke plantar foot from heel to metarsals to big toe
Normal: plantar flexion of toes and foot
Abnormal: dorsiflexion of great toe and flaring of other toes
Lesion location: Corticospinal tract; UMNL
Chaddock Sign Method Normal Abnormal Lesion location
Method: Stroke from lateral malleolus on heel to toe
Normal: no motion of toes and foot
Abnormal: dorsiflexion of great toe and flaring ofthe other toes
Lesion location: Corticospinal tract, UMNL
Oppenheim Sign Method Normal Abnormal Lesion location
Method: Stroke anterior tibial surface from superior to inferior
Normal: no motion of toes and foot
Abnormal: dorsiflexion of great toe and flaring of the other toes
Lesion location: Corticospinal tract UMNL
Gordon Sign Method Normal Abnormal Lesion location
Method: Squeeze the calf
Normal: no motion of the toes and foot
Abnormal: dorsiflexion of great toe and flaring ofthe other toes
Lesion location: UMNL, Corticospinal tract
Schaefer Sign Method Normal Abnormal Lesion location
Method: Squeeze the achilles
Normal: no motion of thetoes and foot
Abnormal: dorsiflexion of great toe and flaring of other toes
Lesion location: UMNL, Corticospinal tract
Pupillary Light Reflex
Segmental innervation
Method
Normal finding
Segmental: Afferent CN II/Efferent CN III
Method: Shine light into one eye watch for constriction in both
Normal: bilateral pupil constriction
Accomodation Reflex
Segmental innervation
Method
Normal findings
Segmental: CN III
Method: Patient look at finger about 2 ft away then follow it in to about 6” away from the nose and then back at an object further away
Normal: Convergence of eyes and constriction of the pupils with lens thickening
Ciliospinal Reflex Afferent Efferent Method Normal finding May signify
Afferent: cervicals and CN V
Efferent: cervical sympathetics
Method: Painful stimulus to side of the neck, pinching the skin
Normal finding: Dilation of the pupil on the painful side
May signify: cervical sympathetic problem
Oculocardiac Reflex Afferent Efferent Method Normal finding
Afferent: CN V
Efferent: CN X
Method: Press thumb pressure on eyeball
Normal finding: Decrease in heart rate
Carotid Sinus Reflex Afferent Efferent Method Normal finding
Afferent: CN IX
Efferent: CN X
Method: Pressure on carotid sinus
Normal finding: Decrease in heart rate and a fall in the blood pressure
Bulbocavernosus Reflex
Segmental Innervation
Method
Normal finding
Segmental Innervation: S3-S4
Method: Stroke, pinch, prick the dorsum of the glans of penis
Normal finding: Contraction of the bulbocavernosus muscle, urethral constriction and contraction of anal sphincter
