Neuro Limb exam Flashcards
Main things to figure out in limb exam
UMN,-nerve root, plexus, peripheral nerve, mono
LMN,
cerebellar (DANISH),
parkinsons
fatiguable etc
which one can it be
Upper limb start
Inspect well-the muscle bulk ,scars (front or back), fasciculations,
resting tremor, etc
comfy at 45 degrees
quick screening tests-
close eyes and keep hands up (pronator drift)
then touch nose with both fingers
then gently tap
quickly tells you- pronator drift, proprioception, strenght at least 4/5/REBOUND- cerebellar
Upper montor tone
ask if any pain
key is passive movement
move wrist around- rotate around elbow and wrist
elbow, shoulder
Increase-spastic tone- catch as speed up
Lower -hard to find (can say not increased)
then power
Upper motor power
instruction CLEAR, and both sides
make sure they lift on their own for 3/5
and let them do the start of the movement
chicken arms
Boxer arms–support elbow n staighten, and back in
Wrist-cock up and down
Fingers-press down, press in
thumb up to ceiling
then reflexes
Upper motor reflexes
Biceps-looks at movement and biceps muscle-c5/c6 (mainly C5)
brachio radialis-base of thumb lower-C6
triceps-cross arm over-C7
clench teeth if you cant get it
keep power equal
really shows how good you are
then coordination
Upper motor coordination
based on if they can move-if arms too weak maybe do legs
watch for intention tremor
go nose to finger-move-MAKE ARM STRETCH
then hand on the other and flip it
then other hand
fastish
(==>cerebella=ipsilateral)
then sensation
Upper motor sensation
Different modalities–
different ways and how
want to test different tracks-
Pin prick/fine touch-spinothal
Proprioception-dorsal
light touch is both, not superuseful
follow dermatomes, and check peripheral glove n stocking distribs (go straight up and ask if feel the same)
vibration-128hz -placed on the bone part-go up if cant feel it-ask when vibrate and when stop
Proprio-grab from side and small movements-
is it hemisensory?-cord
is it dermatome
is it mixed
is it mono
Upper motor findings present
either positives first
or just in order
Lower limb start
Examine legs first- at 45 degrees
UMN vs LMN vs cebellar
expose all leg
tremors
surgery scars-like knee
look at sole of the feet-ulcer, corn (like neuropathies)
gait is the screening test-either first or end
Lower limb tone
relax both legs
and then roll-check foot movement
then lift knee up-from bottom- and see if foot lift (normal-foot stays on bed)
Clonus-bend knee->move the foot up
Lower limb power
whole leg up
knee up (towards bottom) and kick forward
both legs
then dorsiflex and press up
then press down
if dorsiflex issue- check eversion and inversion of ankle -helps difference between common peroneal (dosriflex and inversion down)
Lower limb reflex
knee- L3/L5-feel, gently bend and tap-
care if operations
Achilles tendon/ankle-L5/S1-knee at 90 degrees sideways, dorsi the ankle and hit tendon
Plantar- orange baton-go all the way around the foot-from heel to toes-down is good
then sensory
Lower limb sensory
same as upper
dermatome and peripheral neve
fine touch do
and offer those- examiner will let you know for pinprick
proprio
vibration
Lower limb coordination and extras
GAIT-walk to end of room
look at arms movement, limping, size of steps
and the heel strike, swinging and rest
walking,
heel toe-like on a rope-ataxia
Rhombergs-proprioception test–start by just checking they ARE steady. then close eyes-+ve->unsteady
ataxia-unsteady with eyes open
main gaits-
antalgic-knee or hips
Ataxic
Parkinsonian/shuffling/low arm swing, leaning forward
neuro limb ddx
UMN on one side-> Contralateral hemishepre, hemicord?
LMN- Mixed-radiculo, plexus,, nerve
=> then dermatome?- spine
=> nerve distib?-nerve issue
=> more/less-other
Only sensory-peripheral (gloves)
