PRACTICAL: Motor System EXAMINATION Flashcards by Deependra Singh

Motor System Examination POINTS
🧠⚡The:ABCDEFG ⚡

Tone Assessment
Attitude of the limb
Bulk of the muscle
CoorDination
Examination of POWER
reFlexes
Gait

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Attitude
Define

Position of the limb which it adopts when the patient is in RESTING POSITION

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Attitude of UPPER LIMB IN HEMIPLAGIA

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Lower LIMB Attitude in HEMIPLEGIA

⭐ EXTENDED at HIP and Knee
⭐ Externally Rotated at HIP
⭐ FOOT INVERTED
⭐ PLANTAR FLEXED

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Erb’s Paralysis

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PARAPLEGIA ATTITUDE

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PLEGIAs

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Wasting is considered if

⭐ Reduction in Dominant Extremity

⭐ Reduction in Non-Dominant Extremity

Wasting is considered if

⭐ Reduction in Dominant Extremity
> 1cm

⭐ Reduction in Non-Dominant Extremity
> 2cm

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Measurements of circumference is done at
🧠⚡Paties: ₹18 ⚡

⭐ 10cm below OLECRONON
⭐ 10cm above MEDIAL EPICONDYLE of HUMERUS
⭐ 18cm ABOVE the PATELLA
⭐ 10cm BELOW the TIBIAL TUBEROSITY

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Pseudo-HYPERTROPHY
Cause?
6 CAUSES

⭐ ⭐ INCREASED FAT IN MUSCLE
CAUSES:
1. DUCHENE’S MUSCULAR DYSTROPHY
2. BECKER’S MUSCULAR DYSTROPHY
3. HOFFMAN DISEASE
4. KOCHER-DEBRE-SEMELAIGNE Syndrome
5. MYOTONIA CONGENITA: THOMSEN’S DISEASE
6. STORAGE DISORDERS
7. Juvenile SMA Type 2: KUGELBERG WELANDER DISEASE

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Hypothyroidism
➕
Pseudo-HYPERTROPHY
In Adults?
🧠⚡ MAN is adult⚡
In Children?
🧠⚡KOCH in malyalam = Child ⚡

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Kocher Syndrome
Synonyms

⭐ Kocher-Debre-Semelaigne Syndrome
⭐ Infantile HERCULES Syndrome

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True MUSCULAR HYPERTROPHY

Exercise

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Localised MUSCLE SWELLING
HAMo TRC

⭐ HEMORRHAGE in the muscle
⭐ MYOSITIS OSSIFICANS
⭐ ABSCESS
⭐ TUMOR
⭐ RUPTURE of Muscle
⭐ CYST (CYSTICERCOSIS)

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Generalized MUSCLE WASTING
Seen in
🧠⚡MAT²CH- Aids ⚡

Malignancy
Cachexia
TB
Thyrotoxicosis
Addison’s Disease
HIV/AIDS

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PROXIMAL MUSCLE WASTING
Seen in

⭐ MOTOR NEURON DISEASE
⭐ MUSCULAR DYSTROPHY
⭐ INFLAMMATORY MYOPATHIES: Polymyositis, etc
⭐ PLEXOPATHIES
⭐ AXILLARY NEUROPATHY (LARGE FIBER NEUROPATHY)

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Inflammatory MYOPATHIES

⭐ Polymyositis
⭐ Dermatomyositis
⭐ Inclusion Body MYOSITIS
⭐ Autoimmune NECROTIZING MYOPATHIES (AINM)

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DISTAL MUSCLE WASTING
Seen in:

⭐ ANTERIOR HORN CELL DISEASE: Polio, MND
⭐ Syringomyelia, Intramedullary tumours
⭐ Small Fibe Peripheral POLYNEUROPATHY
⭐ Myotonic DYSTROPHY
⭐ Plexopathies: Lower Brachial Plexus injuries
⭐ Arthritis: Rheumatoid
⭐ Disuse ATROPHY

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HAND MUSCLE WASTING

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SPLIT HAND SIGN
Seen in

AMYOTROPIC LATERAL SCLEROSIS

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TONE
Define

⭐ RESISTANCE FELT DURING PASSIVE JOINT MOVEMENT

⭐ Partial state of Contraction of the muscle at REST which is demonstrated by RESISTAMCE OFFERED BY MUSCLE TO Passive Movement across the joint

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TONE assessment is done in

⭐ UPPER LIMB (Wrist and Elbow joint)

⭐ LOWER LIMB (KNEE and ANKLE joint)

⭐ TONE of BICEPS is assessed during

⭐ TONE of TRICEPS is assessed during

⭐ TONE of BICEPS is assessed during
✨ EXTENSION

⭐ TONE of TRICEPS is assessed during
✨ FLEXION

Tone is dependent on

VELOCITY-DEPENDENT

Tone of the muscle is DUE TO:

⭐ Integrity of REFLEX ARC ⭐ LOW FREQUENCY and ASYNCHRONOUS Discharge of GAMMA- MOTOR NEURONS

⭐ Rate of GAMMA-MOTOR NEURON Discharge is LOW ⭐ Rate of GAMMA-MOTOR NEURON Discharge is HIGH

⭐ HYPOTONIC ⭐ HYPERTONIC

TONE OF HIP is checked by

Rolling the THIGH Side-to-side

Erb's PARALYSIS 🧠⚡ADIR: Prone ➡️ POSITION OF LIMBS ⚡

Policeman Hand Deformity Adduction ➕ INTERNAL ROTATION ➕ Pronation

TONE OF KNEE joint is checked by

METHOD1: Place hands behind the patient's knee and lift the leg in a sudden motion ⬇️ Observe if HEEL Drags along the BED ⬇️ Represents NORMAL TONE METHOD 2: DO FLEXION AND EXTENSION OF THE KNEE JOINT

HYPERTONIA OF KNEE is checked by

Foot does not make contact with the BED after the maneuver

TONE OF WRIST is checked by

Do Flexion and Extension at WRIST JOINT ⬇️ Do Circular Motion of the WRIST

TONE OF ELBOW JOINT is checked by

⭐ Flexion and Extension ⭐ Supination and Pronation of Forearm

TONE OF ARM is checked by

⭐ Flexion and Extension of Shoulder Joint ⭐ Adduction and Abduction of Shoulder

HYPOTONIA

Causes of HYPOTONIA

1. LMN Lesion -motor side of reflex arc affected -sensory side -combined motor ➕ sensory -lesion of Muscles -lesion of NMJ 2. Stage of NEURONAL SHOCK in UMN lesion 3. Cerebellar lesions 4. Chorea 5. Periodic Paralysis 6. REM SLEEP 7. BZD overdose 8. Neuromuscular blockers 9. HYPOTHYROIDISM 10. DOWN Syndrome 11. HYPERMAGNESEMIA

Types of HYPERTONIA SPASTICITY vs RIGIDITY 🧠⚡ Rigidity has Extra R⚡ 🧠⚡ Gamma motor excess common for both ⚡

Causes of SPASTICITY

Causes of HYPERTONIA

1. SPASTICITY 2. Rigidity 3. TETANUS 4. SEIZURES (TONIC PHASE) 5. TETANY 6. CATATONIA 7. PARATONIA -Geganhalten -Mitgehen 8. Strychnine poisoning

Fasiculations vs FIBRILLATION

Fasiculations seen in : Motor neuron or Axonal DEGENERATION FIBRILLATION : Anterior Horn cell diseasea

Causes of Fasiculations

1. Amyotrophic Lateral Sclerosis 2. SMA 3. Post POLIO Syndrome 4. HyperThyroidism 5. Organo phosphorus poisoning 6. Atropine, Lithium 7. Mercury 8. Benign Fasiculations

Myotonia Meaning

Muscle contraction continues beyond the period of time required for a particular movement, there is FAILURE of Normal Muscle Relaxation ✨ CONTINUED, INVOLUNTARY MUSCLE CONTRACTION EVEN AFTER CESSATION OF VOLUNTARY EFFORTS

MYOTONIA is Best seen in Muscles of

Face : continued smiling Hand : Delay in relaxation of grip

Myokymia Seen in

Continuous RIPPLING/VERMICULAR movement of a group of muscle fibers that can be seen in NEUROPATHIES ✨ GBS ✨ Plexopathies ✨ Isaac Syndrome

Cause of MYOTONIA

1. Myotonic Dystrophy Type 1 and 2 2. MYOTONIA Congenita 3. Paramyotonia Congenita 4. Hyperkalemic Periodic Paralysis

Clasp Knife Phenomena

Increased TONE only during the INITIAL PHASE ⬇️ After a point ⬇️ SUDDEN LOSS OF TONE

Muscles involved in SPASTICITY

Antigravity MUSCLES ⭐ Upper Limb: FLEXORS ⭐ Lower Limb: EXTENSORS

SUPINATOR CATCH seen in

SPASTICITY Supination-Pronation of the forearm will reveal it

Klumpke's PARALYSIS 🧠⚡FESs High ⚡ 🧠⚡ Klump = clamp = Holding tree⚡

Elbow Flexed ➕ Supinated Forearm ➕ U/L HORNER SYNDROME

Erb's Palsy root value

CATATONIA

Altered tone of the muscle in ⭐ B/L FRONTAL LOBE DYSFUNCTION ⭐ DIFFUSE CEREBELLAR DISORDERS

Oppositional CATATONIA (OR) Gegenhalten

Subject involuntarily RESIST PASSIVE MOVEMENTS

FACILITATORY PARATONIA (OR) MITGEHEN

Subject involuntarily assists PASSIVE MOVEMENT

Qualitative Assessment of POWER or WEAKNESS by

MRC Grading

MRC Grading of POWER of Muscle

Grade 0- No contraction Grade 1- Flicker or trace of contraction Grade 2- Active movement, with gravity eliminated Grade 3- Active movement against gravity Grade 4- Active movement against gravity and resistance Grade 5- Normal power Grades 4- : movement against slight resistance Grades 4 :movement against moderate resistance Grades 4+ :movement against Strong resistance