motor system examination practical notes(macloed)

Dr.Yunis 5/10/2015

--Hypotonia :-flaccidity:is a feature of :-
1-LMN lesion
2-cerebellar disease
3-spinal shock
4-cerebral shock.
Associated features:-
1-wasting
2-weakness
3-hyporeflexia

spasticity

Rigidity
1.velocity dependent R to passive movement,it is detected as a catch at the beginning or end of passive movement
1.sustained R through out the range of movement
2.detected with quick movement
2.detect when the limb is moved slowly
3.associated with:-weakness,hyperreflexia&extensor plantar response&clonus
3.lead pipe rigidity(no tremor),,if tremor is present it is (cog wheel )
Bestly detected in the wrist joint
4. it is a feature of UMN lesion
4.also & it is of extrapyramidal tract features


--clonus:-rhythmic series of contractions evoked by sudden stretch of muscles
--there is physiological clonus in healthy individual
--======pathological clonus
--how to differentiate between them?
If it is sustained it is pathological
--what indicates ?it indicates UMN lesion
--which feature accompany clonus?spasticity

Myoclonic jerk:-

Sudden shock like contraction of one or more of the muscles
Pattern of myoclonic jerk:-
1.singly
2.repetitively
3.focal
4.diffuse

Types :-

1.physiological
2.pathological

How to differentiate between the two types ?

By EEG .


Diseases in which myoclonic jerks occur?
1.epilepsy
2.dementia
3.brain damage

What is the difference between fibrillation & fasciculation?

Fasciculation is evident by eyes
Fibrillation is NOT evident by eyeswe need EMG to detect it .

Note :-both fibrillation & fasciculation are UMN lesion.

--what are points we inspect in neurological exam?
1.wasting
2.hypertrophy
3.asymmetry
4.abnormal movement
5.posture
6.atrophy
7.deformity
8.signs of trauma& surgery


Before doing any reflex firstly palpate the muscle tendon then tap on it.
Elevate the hummer 45 degree then tap (NOT 90 degree)
Always compare between the two sides because of asymmetry.
You can tap on any tendon only 3 times .

Normally there is plantar flexion

If dorsiflexion occurred UMN lesion
Sometimes funning of the toes occursalso UMN lesion
Before doing this reflex ,ask permission from the pt(this maneuver is noxious)
You can repeat this reflex 2 times only
Sometimes equivocal plantar reflex occurUMN lesion

Tone:-resistance felt by the examiner when he moves the pt's limb passively

Normal tone is imp?
--To maintain normal posture & position.

*both are signs of UMN lesion

*in Hoffman signflexion of pt's thumb.
*in finger jerkthere will be flexion & adduction of thumb.

Ruqaya falah omer