Neurological Examination of Limb

Upper Limb
1. Introduction
2. Inspection
  1. posture & symmetry
  2. symmetry, size & shape of muscles
  3. scars & bruising
  4. abnormal movements
    1. athetosis
    2. dystonia
    3. intention tremor
  5. fasciculation
3. Assessment of Tone
  1. ask patient to relax arm
  2. put each major joint through a full range of movement
4. Assessment of Power
  1. shoulder abduction
  2. Elbow
    1. Flexion
    2. Extension
  3. Finger
    1. Flexion
    2. Abduction
    3. Adduction
  4. Thumb abduction
  5. Scoring System
    1. 0 no movement
    2. 1 muscle belly moves but joint does not move
    3. 2 Joint moves with gravity eliminated
    4. 3 Joint moves against gravity
    5. 4 joint moves against gravity & resistance
    6. 5 Full strength
5. Tendon Reflexes
  1. Biceps C6
  2. Triceps C7
  3. Brachoradialis C6
  4. Jendrassik's maneuvre
6. Sensation
  1. Dorsal Column
    1. vibration
    2. Proprioception
    3. Light touch
    4. 2 point discrimination
  2. Spinothalamic
    1. Pain
    2. Temperature
    3. some light touch
7. Coordination
  1. finger-nose
  2. finger-finger
    1. tremor & overshooting
  3. Alternating hand movements
    1. dysdiadochokinesia
  4. Fine movement
  5. Cerebellar drift (rebound)
8. Conclusion
Lower Limb
1. Inspection
  1. Muscle Wasting
  2. Asymmetry
  3. Fasciculation
2. Tone
  1. ankle clonus
  2. roll leg on bed to assess ease of movement
  3. pull up on knee
3. Power
  1. hip flexion
  2. hip extension
  3. knee flexion
  4. knee extension
  5. dorsiflexion
  6. Plantarflexion
  7. Toe Plantarflexion
  8. Toe Dorsiflexion
4. Reflexes
  1. Patellar
  2. ankle
  3. plantar
5. Function
  1. Romberg's test
6. Sensation
  1. Dorsal Column
    1. Vibration
    2. Proprioception
    3. Discriminative Touch
  2. Spinothalamic
    1. Pain
    2. Temperature
    3. Non-discriminative light touch
Elements that need to be intact
1. Brain
2. Spinal Cord
3. Peripheral Nervous System
4. Muscles
5. Tendons & Attachments
6. Bone
Method
1. Inspection
2. Palpation
3. Auscultation
4. Percussion
Comparison
1. Left to Right
2. Proximal to distal
3. Upper & Lower Motor Neurone lesions
Test for
1. Tone
2. Power
3. Reflexes
4. Sensation
5. Coordination

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Neurological Examination of Limb

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