Upper neuro exam Flashcards
What is chorea?
brief irregular movements that are not repetitive or rhythmic
often in patients with Huntington’s disease
What is opthalmoplegia?
wide range of neurological disorders
e.g. MS and myasthenia gravis
What is pronator drift?
What does the outcome mean?
assesses mild upper limb weakness and spasticity
- hold arms out in front with palms upwards
look for signs of pronation - no pronation, ask patients to close their eyes and observe again
Interpretation= pronation with(out) downward movement= pronator drift= contralateral pyramidal tract lesion (UMN lesion= supinator muscles in forearm are weak)
How do you test for tone in muscle groups?
support arm
relax patient and fully control their movement (elbow= flexion and extension, shoulder and wrist= circumduction)
feel for:
-spasticity, rigidity, cogwheeling, hypotonia
Spasticity vs rigidity?
spasticity= pyramidal tract lesions (stroke)
(faster move limb= worse + linked weakness)
rigidity= extrapyramidal tract lesions (parkinson’s disease)
(same feeling if move limb rapidly or slowly- velocity independent)
**both increased tone
What type of rigidity is linked to parkinson’s disease?
cogwheel
tremor superimposed on hypertonia, resulting in intermittent increases in tone during movement of limb
What is lead pipe rigidity? What is it associated with?
increased tone throughout the movement of the muscle
linked to: neuroleptic malignant syndrome
Shoulder abduction test
C5
flex elbow and abduct shoulders to 90˚
apply downward resistance on lateral side of upper arm
Shoulder adduction test
C6/7
adduct shoulder to 45˚ bringing elbows closer to body
apply upward resistance on medial side of upper arm
Elbow flexion test
C5/6
flex elbow
apply resistance by pulling the forearm whilst stabilising shoulder joint
Elbow extension test
C7
elbow flexed
apply resistance by pushing the forearm towards patient + stabilise shoulder joint
Wrist extension test
C6
hold arm out in front of them with their palms facing downwards
make a fist and extend their wrist joints, keep their wrists in this position whilst apply resistance
Wrist flexion test
C6/7
patient still holding arms out in front of them
flex their wrist joints and keep position whilst you apply resistance
Finger extension test
C7
hold fingers out straight whilst you apply downwards resistance
Finger abduction test
T1
abduct fingers against resistance
Thumb abduction test
T1
patient to turn their hand over so their palm is facing upwards and to position their thumb over midline of palm
apply downward resistance with own thumb
patterns of muscle weakness
UMN vs LMN
UMN:
pyramidal pattern of weakness disproportionately affects upper limb extensors and lower limb flexors
LMN:
focal pattern of weakness, only muscles directly innervated damaged neurone affected
MRC muscle power assessment scale:
0- no contraction
1- flicker or trace of contraction
2- active movement, with gravity eliminated
3- active movement against gravity
4- active movement against gravity and resistance
5- normal power
- biceps reflex C5/6
- supinator reflex C5/6
- triceps reflex C7
- thumb of non-dominant hand over tendon and then tap thumb with tendon hammer
- locate brachioradialis reflex (4 inches proximal to base thumb) tap with tendon hammer
- relax triceps tendon, 90˚ flexion on their lap/support patient’s forearm
(triceps tendon= superior to olecranon process of ulna, tap with hammer)
hyperreflexia vs hyporeflexia
hyperreflexia:
UMN lesions
hyporeflexia:
LMN lesions
pendular (less brisk and slower in their rise and fall):
cerebellar disease
How to examine sensation?
- check one modality from dorsal columns and spinothalamic tracts
- eyes closed for assessment
- normal sensation on patient’s sternum
- upper limb dermatomes compare L and R
Arm dermatomes?
C5-T1
C5: lateral aspect of lower edge of deltoid muscle
C6: palmar side of the thumb
C7: palmar side of middle finger
C8: palmar side of little finger
T1: medial aspect antecubital fossa (proximal to medial epicondyle of humerus)
Types of sensation tests
light touch sensation
(DCML and spinothalamic tracts)
pin-prick sensation
(spinothalamic tracts)
vibration sensation
(DCML)
-use tuning fork
What do you examine after sensation?
proprioception
at interphalangeal joint of thumb
How to these present:
- mononeuropathies
- peripheral neuropathy
- radiculopathy
- spinal cord damage
- thalamic lesions
- myopathies
- localised sensory disturbance in area
- symmetrical sensory deficits glove and stocking distribution in peripheral limbs
- nerve root damage= sensory disturbances associated dermatomes
- sensory loss at and below
- contralateral sensory loss
- symmetrical proximal muscle weakness
What does finger to nose test tell us?
cerebellar pathology:
- dysmetria: lack of coordination of movement. Clinically this results in the patient missing the target by over/undershooting
- intention tremor: a broad, coarse, low-frequency tremor that develops as a limb reaches the endpoint of a deliberate movement. =tremor that becomes apparent as the patient’s finger approaches yours. Be careful not to mistake an action tremor (which occurs throughout the movement) for an intention tremor
(both present= ipsilateral cerebellar pathology)
What is dysdiadochokinesia?
inability to perform rapid, alternating movements
feature of ipsilateral cerebellar pathology
(cerebellar ataxia if movements appear slow and irregular)
