Upper Limb Neuro Exam Flashcards
What are you looking for on general inspection?
- scars
- wasting of muscles
- tremor
- fasciculations
- pseudoathetosis
- chorea
- myoclonus
- tardive dyskinesia
- hypomimia
- ptosis and frontal balding
- Opthalmoplegia
What scars are you looking for?
previous spinal, axillary or upper limb surgery
What would wasting of muscles suggest?
LMN lesions or disuse atrophy
What are fasciculations?
small, local, involuntary muscle contraction and relaxation which may be visible under the skin
What are fasciculations associated with?
lower motor neuron pathology (e.g. amyotrophic lateral sclerosis)
What is pseudoathetosis?
abnormal writhing movements (typically affecting the fingers) caused by a failure of proprioception
What is chorea?
brief, semi-directed, irregular movements that are not repetitive or rhythmic but appear to flow from one muscle to the next
When may chorea usually be present?
Huntington’s disease
What is myoclonus?
brief, involuntary, irregular twitching of a muscle or group of muscles
What is persistent widespread myoclonus associated with?
several specific forms of epilepsy (e.g. juvenile myoclonic epilepsy)
What is tardive dyskineasia?
involuntary, repetitive body movements which can include protrusion of the tongue, lip-smacking and grimacing
When might people experience tardive dyskineasia?
secondary to treatment with neuroleptic medications including antipsychotics and antiemetics
What is hypomimia?
reduced degree of facial expression
What is hypomimia associated with?
Parkinson’s disease
What is ptosis and frontal balding associated with?
myotonic dystrophy
What is ophthalmoplegia?
weakness or paralysis of one or more extraocular muscles responsible for eye movements
What can opthalmoplegia be caused by?
lots esp multiple sclerosis and myasthenia gravis
What objects do you look for around the bed?
- walking aids
2. prescription
What would pronator drift indicate?
contralateral pyramidal tract lesion
What is spasticity associated with?
pyramidal tract lesions (e.g. stroke)
What is rigidity associated with?
extrapyramidal tract lesions (e.g. Parkinson’s disease)
What does spasticity and rigidity both involve?
increased tone
What is the difference between spasticity and rigidity?
s is velocity dependent so faster move limb worse it is and r is velocity independent
What are two main subtypes of rigidity?
- Cogwheel rigidity (parkinson’s)
2. lead pipe rigidity (neuroleptic malignant syndrome)
What myotome and muscle is assessed in shoulder abduction?
- C5 (axillary nerve)
2. Deltoid and other should abductors
What myotome and muscles assessed in shoulder adduction?
- C6/7 (thoracodorsal nerve)
2. Teres major, latissimus dorsi and pectroalis major
What myotome and muscles are assessed in elbow flexion?
- C5/6 (musculocutaenous and radial nerve)
2. Biceps brachii, coracobrachialis and brachialis
What myotome and muscle is assessed in elbow extension?
- C7 (radial nerve)
2. Triceps brachii
What myotome and muscle is assessed in wrist extension?
- C6 (radial nerve)
2. Extensors of the wrist
What myotome and muscle is assessed in wrist flexion?
- C6/C7 (median nerve)
2. Flexors of the wrist
What myotome and muscles are assessed in finger extension?
- C7 (radial nerve)
2. Extensor digitorum
What myotome and muscle is assessed in finger abduction?
- T1 (ulnar nerve)
2. First dorsal interosseus and abductor digiti minimi
What myotome and muscle is assessed in thumb abduction?
- T1 (median nerve)
2. Abductor pollicis brevis
What is the pattern of muscle weakness like in UMN lesions?
- ‘pyramidal’ pattern of weakness that disproportionately affects upper limb extensors and lower limb flexors
- upper limb extensors are weaker than flexors in an upper limb neurological assessment
What is the pattern of weakness in LMN lesions?
focal pattern of weakness, with only the muscles directly innervated by the damaged neurones affected
What is the reinforcement manoeurve?
asking the patient to clench their teeth together whilst you simultaneously tap the tendon (if reflex absent)
What does the biceps reflex test?
C5/C6
What does the supinator (brachioradialis) reflex test?
C5/C6
What does the triceps reflex test?
C7
What does hyperreflexia usually result from?
UMN lesion
What is hyporeflexia usually associated with?
LMN lesions
What are reflexes like in cerebellar disease?
- ‘pendular’
2. Less brisk and slower in their rise and fall
What does light touch sensation test?
- dorsal columns
2. spinothalamic tracts
What does pin prick (pain) sensation test?
spinothalamic tracts
What do you do if loss of sensation is notes distally?
test for “glove” distribution of sensory loss (associated with peripheral neuropathy) by moving distal to proximal
What does vibration sensation test?
dorsal columns
What does proprioception test?
dorsal column
What are the different patterns of sensory loss?
- mononeuropathies
- peripheral neuropathy
- radiculopathy
- spinal cord damage
- thalamic lesions
- myopathies
