1 / 23

NEUROLOGICAL EXAMINATION OF THE LIMBS

GENERAL ORDER OF EXAMINATION. Gait (if appropriate)InspectionTonePowerReflexesCoordinationSensation. SOME ABNORMAL GAITS. SpasticHemipareticParkinsonianFootdropAtaxicWaddling myopathic. INSPECTION. Muscle wasting and/or fasiculationAbnormal postureTremorsInvoluntary movements. MUSCLE

placido
Download Presentation

NEUROLOGICAL EXAMINATION OF THE LIMBS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. NEUROLOGICAL EXAMINATION OF THE LIMBS

    2. GENERAL ORDER OF EXAMINATION Gait (if appropriate) Inspection Tone Power Reflexes Coordination Sensation

    3. SOME ABNORMAL GAITS Spastic Hemiparetic Parkinsonian Footdrop Ataxic Waddling myopathic

    4. INSPECTION Muscle wasting and/or fasiculation Abnormal posture Tremors Involuntary movements

    5. MUSCLE WASTING A lower motor neuron sign, ie due to lesion in the muscle, nerve,plexus, root or anterior horn cells Takes several weeks to develop May be generalised or focal If focal can help to localise a lesion

    6. FASICULATION A lower motor neuron sign Occurs in actively denervating muscles Represents spontaneous discharges of single motor units Lesion in the nerve, plexus, root or anterior horn cells

    7. TREMORS Tremors may be resting, postural or action Resting tremor often unilateral and due to Parkinsons disease: associated with rigidity, gait disturbance and bradykinesia Physiological tremor enhanced by caffeine, anxiety, beta agonist drugs Benign essential tremor: a postural tremor often familial and alcohol-responsive Cerebellar and midbrain tremors are action tremors: highly disabling

    8. SOME OTHER INVOLUNTARY MOVEMENTS Focal seizures Chorea Athetosis Myoclonic jerks

    9. TONE Reduced muscle tone is hard to detect unless severe. Dont worry about it. Increased tone is much more important and consists of two main types: 1) SPASTICITY (ie pyramidal) 2) RIGIDITY (ie extrapyramidal)

    10. POWER The standard neurological examination involves testing power of two movements at each joint (agonists and antagonists) The history may suggest more localised problems which require examination of individual muscles (eg nerve lesions of the hand) Clear instructions (with demonstrations)

    11. MRC GRADING OF MUSCLE POWER GRADE 5: NORMAL POWER GRADE 4: WEAK BUT SOME RESISTANCE GRADE 3: JUST OPPOSES GRAVITY GRADE 2: MOVES BUT CANNOT OPPOSE GRAVITY GRADE 1: VISBLE MUSCLE FLICKER GRADE 0: NOTHING

    12. PATTERNS OF WEAKNESS Weak arm and leg (same side): HEMIPARESIS (or hemiplegia) Weak legs, normal arms: PARAPARESIS All four limbs weak: TETRAPARESIS One limb weak: MONOPARESIS Proximal muscle weakness Distal muscle weakness

    13. EXAMPLES OF LESIONS CAUSING PATTERNS Hemiparesis: hemispheric stroke, tumour, abscess Paraparesis: spinal cord lesion below cervical spine Tetraparesis: cervical cord lesion Monoparesis: Tumour at brachial plexus Proximal weakness: myopathy Distal weakness: peripheral neuropathy

    14. REFLEXES Reflexes examined in a systematic fashion, comparing one side with the other UPPER MOTOR NEURON LESIONS: increased tendon reflexes, reflex spread and extensor plantar responses LOWER MOTOR NEURON LESIONS: reduced or absent reflexes, may be generalised eg neuropathy, or focal eg single nerve or root lesion

    15. GRADING OF REFLEXES +++: VERY BRISK ++: BRISK, EASY TO ELICIT +: PRESENT +/- : ONLY PRESENT WITH REINFORCEMENT - : ABSENT

    16. COORDINATION Tandem gait Rombergs test Finger to nose test Rapid alternating movements (looking for dysdiadochokinesis) Heel to shin test

    17. CO-ORDINATION (cont.) Two main types of ataxia: Cerebellar ataxia (lesions of the cerebellum and its connections) Sensory ataxia: peripheral neuropathies and spinal cord lesions where dorsal columns are affected

    18. SENSATION Tailored sensory examination if the history and motor examination suggests it is needed IN ORDER TO PERFORM A MEANINGFUL SENSORY EXAMINATION, YOU NEED TO KNOW WHAT PATTERN OF SENSORY LOSS YOU ARE LOOKING FOR!

    19. PATTERNS OF SENSORY LOSS Sensory peripheral neuropathy Individual nerve lesions Mononeuritis multiplex Root lesions Plexus lesions Spinal cord lesions Brainstem syndromes

    20. SENSORY PERIPHERAL NEUROPATHY Distal symmetrical sensory loss Affects legs> arms May affect predominantly large fibres (vibration sense, proprioception), or small fibres (pain and temperature), or both

    21. INDIVIDUAL NERVE OR ROOT LESIONS Reduced sensation solely in the distribution of a single nerve eg numbness of medial one and a half fingers of the hand in an ulnar mononeuropathy Reduced sensation in the distribution of a single root eg numbness of the lateral border of the foot in an L5/S1 disc prolapse

    22. SPINAL CORD LESIONS ABDOMINAL OR THORACIC SENSORY LEVEL: AN EXTREMELY IMPORTANT LOCALISING SIGN Special situations: Brown-Sequard syndrome (hemicord), anterior spinal artery syndrome etc.

    23. UPPER MOTOR NEURON LESIONS Weakness Increased tone (spasticity) Increased reflexes Extensor plantar responses

    24. LOWER MOTOR NEURON LESIONS Weakness Wasting (after several weeks) Fasiculations (if active denervation) Reduced tone (if detectable) Reduced or absent reflexes Normal (flexor) plantar responses

More Related