Neurological Examination of Limbs Flashcards Preview

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Flashcards in Neurological Examination of Limbs Deck (13)
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1
Q

What are the overall steps to a neuro exam of the limbs?

A

Arms and legs:

  • Inspection
  • Tone
  • Power
  • Coordination
  • Reflexes
  • Sensation

Gait

2
Q

What are you looking for on inspection?

A
Scars/skeletal deformities
Wasting of the muscle
Involuntary movements - dystonia, chorea/athetosis, ballismus, ticks
Fasciculations
Tremor
3
Q

How do you check tone of the arms? What are you looking for

A

Elbow flexion/extension
Forearm pronation/supination
Wrist flexion/extension

Compare both sides
Consider sudden movements to ensure no voluntary muscle contraction from patient

Looking for spasticity (UMN lesion) or rigidity (extra-pyramidal)

4
Q

How do you check power of the arms?

A
Shoulder abduction
Elbow flexion/extension
Wrist flexion/extension
Fingers - flexion (squeeze), extension (use side of hand to push), intrinsic (spread fingers and stop from pushing in), thumb abduction
Pronator drift

Grade on MRC 0-5

5
Q

How do you test coordination in the arms?

A
Outstretched arms (tremor/dystonia)
Finger-nose test - both sides
Rapid alternating hand movements - dysdiadochokinesis - both sides
6
Q

How do you test the reflexes in the arm, and which spinal levels are they testing?

A

Biceps - C5/6
Supinator - C6
Triceps - C7

Both sides
Reinforce with teeth clench or hand squeeze

7
Q

How do you test sensation in the upper limb?

A
Light touch - cotton wool
- C5-8, T1
Pinprick sensation - same areas
Vibration sense - small tuning fork (128Hz) - on joint, move proximal until felt
Joint position sense
8
Q

How do you assess tone of the legs?

A

Hip rotation
Knee drop
Ankle clonus - sudden, but fairly small, dorsiflexion

9
Q

How do you assess power in the legs?

A

Hip flexion/extension (push thigh against hand and push down)
Knee flexion/extension (bend knee and push/pull)
Ankle dorsiflexion/plantarflexion
Bit toe extension

10
Q

How do you assess coordination in the legs?

A

Heel-shin test

11
Q

What reflexes are tested in the lower limb and which spinal levels do they correspond with?

A

Knee - L3,4
Ankle - S1
Plantar response (normal is down)
Reinforce by interlocking fingers and pulling

12
Q

How is sensation tested in the lower limb?

A

Light touch - L2-5, S1
Pinprick - same areas
Vibration sense
Joint position sense

Romberg’s test

13
Q

How is gait assessed?

A

Rise from sitting without using arms
Walking and turning
Tandem walking
Walking on tiptoes and heels