PNS Flashcards
(19 cards)
UMN signs
Increased tone, clonus
Weak : arm extensors, leg flexors
Brisk reflexes
Extensor/babinski plantars
BG lesions = Parkinsonism
Caudate nuc/putamen = ballism, tics
LMN signs
MW fasiculation N or reduced tone, no clonus Focal ie nerve distrib weakness Reduced/absent reflexes Normal ie flexor plantars
Lower limb observe
Assymetry/deformity prox and distal also wasting, deformity, hypertrophy, fasiculation, invol mvt
STAND
Balance stand feet together
Close eyes ROMBERG ie sensory ataxia +ve = fall
Push pull test
Gait = walk 10m, heel toe, then each! PD - tremor/shuffling L5, common peroneal nerve = Foot drop - slapping, inc tiptoes Cerebellar = wide based, ataxic Myopathy = waddle, +ve trendelenberg CVD/hydrocephalus = apraxia
Lower limb muscles
Assymetry/deformity prox and distal
Bulk - wasting/hypertrophy MEASURE QUADS
?fasciculation ie flick / invol mvts
Tremor = invol oscillatory mvt Frequency Amplitude Position Body part
N = fine, fast ie Th, caffine, etoh
PD = slow, coarse, pill rolling
Increase: rest, UL
Head = dystonia
Cerebellar = intention
Neurop ie CMT
Drugs ie valproate
Other abn mvts: chorea, athetosis
TONE
Resistance to passive mvt
Test: slow and fast, unpredictable, full ROM
FIRST ROLL LEGS/LIFT AND DROP
PATELLAR ie briskly push down ie clonus
ANKLE CLONUS - both at 90 support, briskly dorsiflect and evert foot, maintain
LMN reduced
UMN increased = SPASTICITY = velocity dependent ie faster = catch beginning and end
CLONUS = rhythmic contractions sustained in UMN 6+ beats
PD = rigidity = sustained throughout ie lead pipe +- tremor = cogwheeling MD/MYOTONIA = stiffness
REFLEXES before POWER
Monosynapic ie stretch receptor - efferent to sc then afferent to muscle
Strike thumb - biceps/supinator
Hold wrist - elbow
Finger jerk - hold hand tap up
C5/6 biceps and supinator
C6/7 triceps
C8 finger
Knee l3/4
Ankle s1
PLANTARS s1/2 n=down
Reflex patterns
UMN increased
Decreased
LMN ie radiculopathy
Holmes Adie
POWER
MRC 5 n against resistance and gravity 4 resistance = weaker 3 gravity 2 w/o gravity 1 flicker 0 nil
SLR ie hip flex
Knee f e
Ankles - dorsiflect/planters
Power areas
Shoulder abd deltoid C5 Elbow flex C5/6 Elbow ext C7 Wrist ext C6 Finger flex C8 Finger ext C7 Finger abd T1
Hip flex L1/2 Hip ext L5/S1 Knee flex S1 Knee ext L3/4 Ankle dorsi L4/5 Ankle plantar S1/2
Power patter
Myopathy = proximal mw Neuropathy = distal ie glove/stocking MG = fatiguability
Paresis - partial Plegia - complete Monoplegia - single limb Hemiplegia - one half body Paraplegia - legs Tetraplegic - all limbs
COORDINATION
Finger nose ie past pointing, intention tremor SHOULD BE FAST
Dysdiadochokinesia ie palm ?clumsy/slow eg dyssnyergia
Heel - shin
?foot tap
If ETOH or midline c only abn may be GAIT!
APRAXIA ie cortical = imaginary tasks/copy mvts ie non-dominant parietal or frontal = constructional
ABDO REFLEXES ie q stroke med
SENSATION
Light touch - cotton wool IREG!
Pain - neurotip
Temp - cold metal
VIBRATION - 128 hz move distal ie from big toe/DIPJ and stop!
PROPRIOCEPTION - same ie direction big toe look first
COMPARE
? VISUAL INATTENTION - touch both
STEREGNOSIS objects
L2 side of hip L3 med knee L4 med calf L5 lat calf + foot dorsum S1 lat foot m + sole ?S2 underside of calf
Sensation patterns
VIBRATION PROPRIOCEPTION - dorsal post columns, deccusate at medulla = FAST LARGE MYELINATED
PAIN TEMP - PNs spinothalamic tracts, thalamus, parietal, deccusate few segs above = SLOW SMALL
LENGTH DEPENDENT PN ie glove and stocking LL>UL
DEMYELINATING PN ie UL FIRST
GB ie LARGE FIBRE ie vib and prop - romberg, pseudoa??
DM / HIV SMALL FIBRE ie pain, temp
Upper limb OBSERVE
Prox/distal
Asymmetry
?deformity ie clawing
TREMOR
PRONATOR DRIFT!! = spasticity/UMN
MW/hypertrophy feel bulk ie then at
Fasciculation - flick skin over muscle
Invol mvt
Upper Limb TONE
Hold as if shaking hand, hold elbow, move all joints
Vary speed/direction
Compare sides
?WRIST CLONUS
?spacitcity v rigidity
Upper limb REFLEXES
Biceps c5 thumb
Supinator c6
Triceps c7
Finger jerks - own fingers palmar prox phalanges ?flexion
Hoffman DIPJ middle finger FLEX DOWN W THUMB,
look for pathological FLEXION IN THUMB
Reinforcement- clench teeth, other hand
Upper limb POWER
Abd c5
/add
Elbow f c5-6 e c7
Finger abd - dorsal inerosei + add dig min c8
Grip c8
Upper limb COORDINATION
REBOUND - arms out quickly push down
Finger nose - slow then rapid
Dysdiadochkinesia
FUNCTION ie tasks / apraxia
?Dispraxia ie mine tasks
Construction ie parietal - copy shapes
Sentence ie Lang plus motor dysgraphia = dominant parietal lobe
Dressing ie spacial disorientation or neglect = non dominant parietal
Upper limbs SENSATION
Light touch ie look away DABBING DERMATOMES
Neurotip - check sharp v dull
Temp cold metallic
VIBRATION 128 move in ie Distal ps, middle
PROPRIOCEPTION check first HOLD AT SIDES
Two point discrim ie paper clip thumbs and middle ?min sep
Stereognosis ie objects in palm eyes shut
Graphasthesia ie draw figures on palm orange stick
Point localisation ?finger agnosia
LEFT RIGHT BOTH ? inattention
C5 deltoid C6 biceps/forearm lat Lat thumb C7 first two ie median C8 last two ie ulnar T1 inner forearm
