Enviar búsqueda
Cargar
Muscle Power and Tone Examination
•
344 recomendaciones
•
118,475 vistas
M
meducationdotnet
Seguir
Denunciar
Compartir
Denunciar
Compartir
1 de 49
Descargar ahora
Descargar para leer sin conexión
Recomendados
Upper and lower motor neuron
Upper and lower motor neuron
Muhammad Saim
Examination of motor system
Examination of motor system
8224080546
Cranial nerve examination
Cranial nerve examination
Gagan Gupta
CNS examination
CNS examination
Walaa Manaa
Sensory Examination
Sensory Examination
meducationdotnet
Cerebellar examination
Cerebellar examination
rzgar hamed
Higher mental function
Higher mental function
Pratap Tiwari
clinical examination of spine
clinical examination of spine
Hardik Pawar
Recomendados
Upper and lower motor neuron
Upper and lower motor neuron
Muhammad Saim
Examination of motor system
Examination of motor system
8224080546
Cranial nerve examination
Cranial nerve examination
Gagan Gupta
CNS examination
CNS examination
Walaa Manaa
Sensory Examination
Sensory Examination
meducationdotnet
Cerebellar examination
Cerebellar examination
rzgar hamed
Higher mental function
Higher mental function
Pratap Tiwari
clinical examination of spine
clinical examination of spine
Hardik Pawar
Cerebellar signs
Cerebellar signs
Dr. Mayur Patel
Part 5 examination of reflex
Part 5 examination of reflex
Atul Saswat
Clinical Examination of Nervous System - PPT
Clinical Examination of Nervous System - PPT
rajendra deshpande
Differences UMN lesion vs LMN lesion
Differences UMN lesion vs LMN lesion
Dr Nilesh Kate
Superficial reflexes
Superficial reflexes
Kurian Joseph
Clinical Examination of RS
Clinical Examination of RS
Prajwal Rk
nEUROLOGICAL EXAM OF LOWER LIMB
nEUROLOGICAL EXAM OF LOWER LIMB
Ruhul Amin
Clubbing
Clubbing
Prof. Dr. Aswinikumar Surendran
Abdominal Exam
Abdominal Exam
meducationdotnet
Claw Hand,Definition,Causes,Types,Symptoms and Management
Claw Hand,Definition,Causes,Types,Symptoms and Management
Dr.Md.Monsur Rahman
Foot Drop
Foot Drop
Kevin Ambadan
Differences SPASTICITY VS RIGIDITY
Differences SPASTICITY VS RIGIDITY
Dr Nilesh Kate
Clinical examination of cranial nerves
Clinical examination of cranial nerves
Oriba Dan Langoya
Reflexes - Superficial and Deep tendon reflexes
Reflexes - Superficial and Deep tendon reflexes
Chetan Ganteppanavar
Clinical Examination of CVS
Clinical Examination of CVS
Prajwal Rk
EXAMINATION OF THE CENTRAL NERVOUS SYSTEM
EXAMINATION OF THE CENTRAL NERVOUS SYSTEM
Dr ABU SURAIH SAKHRI
Cerebellar ataxia
Cerebellar ataxia
Hanaa Nooh
Examination of the respiratory system
Examination of the respiratory system
Yapa
Guillain-Barré syndrome (GBS)
Guillain-Barré syndrome (GBS)
Prof Vijayraddi
Facial palsy
Facial palsy
Dr. Vibhash Kumar Vaidya
Musculoskeletal Exam
Musculoskeletal Exam
meducationdotnet
Breast Exam
Breast Exam
meducationdotnet
Más contenido relacionado
La actualidad más candente
Cerebellar signs
Cerebellar signs
Dr. Mayur Patel
Part 5 examination of reflex
Part 5 examination of reflex
Atul Saswat
Clinical Examination of Nervous System - PPT
Clinical Examination of Nervous System - PPT
rajendra deshpande
Differences UMN lesion vs LMN lesion
Differences UMN lesion vs LMN lesion
Dr Nilesh Kate
Superficial reflexes
Superficial reflexes
Kurian Joseph
Clinical Examination of RS
Clinical Examination of RS
Prajwal Rk
nEUROLOGICAL EXAM OF LOWER LIMB
nEUROLOGICAL EXAM OF LOWER LIMB
Ruhul Amin
Clubbing
Clubbing
Prof. Dr. Aswinikumar Surendran
Abdominal Exam
Abdominal Exam
meducationdotnet
Claw Hand,Definition,Causes,Types,Symptoms and Management
Claw Hand,Definition,Causes,Types,Symptoms and Management
Dr.Md.Monsur Rahman
Foot Drop
Foot Drop
Kevin Ambadan
Differences SPASTICITY VS RIGIDITY
Differences SPASTICITY VS RIGIDITY
Dr Nilesh Kate
Clinical examination of cranial nerves
Clinical examination of cranial nerves
Oriba Dan Langoya
Reflexes - Superficial and Deep tendon reflexes
Reflexes - Superficial and Deep tendon reflexes
Chetan Ganteppanavar
Clinical Examination of CVS
Clinical Examination of CVS
Prajwal Rk
EXAMINATION OF THE CENTRAL NERVOUS SYSTEM
EXAMINATION OF THE CENTRAL NERVOUS SYSTEM
Dr ABU SURAIH SAKHRI
Cerebellar ataxia
Cerebellar ataxia
Hanaa Nooh
Examination of the respiratory system
Examination of the respiratory system
Yapa
Guillain-Barré syndrome (GBS)
Guillain-Barré syndrome (GBS)
Prof Vijayraddi
Facial palsy
Facial palsy
Dr. Vibhash Kumar Vaidya
La actualidad más candente
(20)
Cerebellar signs
Cerebellar signs
Part 5 examination of reflex
Part 5 examination of reflex
Clinical Examination of Nervous System - PPT
Clinical Examination of Nervous System - PPT
Differences UMN lesion vs LMN lesion
Differences UMN lesion vs LMN lesion
Superficial reflexes
Superficial reflexes
Clinical Examination of RS
Clinical Examination of RS
nEUROLOGICAL EXAM OF LOWER LIMB
nEUROLOGICAL EXAM OF LOWER LIMB
Clubbing
Clubbing
Abdominal Exam
Abdominal Exam
Claw Hand,Definition,Causes,Types,Symptoms and Management
Claw Hand,Definition,Causes,Types,Symptoms and Management
Foot Drop
Foot Drop
Differences SPASTICITY VS RIGIDITY
Differences SPASTICITY VS RIGIDITY
Clinical examination of cranial nerves
Clinical examination of cranial nerves
Reflexes - Superficial and Deep tendon reflexes
Reflexes - Superficial and Deep tendon reflexes
Clinical Examination of CVS
Clinical Examination of CVS
EXAMINATION OF THE CENTRAL NERVOUS SYSTEM
EXAMINATION OF THE CENTRAL NERVOUS SYSTEM
Cerebellar ataxia
Cerebellar ataxia
Examination of the respiratory system
Examination of the respiratory system
Guillain-Barré syndrome (GBS)
Guillain-Barré syndrome (GBS)
Facial palsy
Facial palsy
Similar a Muscle Power and Tone Examination
Musculoskeletal Exam
Musculoskeletal Exam
meducationdotnet
Breast Exam
Breast Exam
meducationdotnet
Continuation of Cranial Nerve Exam
Continuation of Cranial Nerve Exam
meducationdotnet
Examination of Lower Limbs
Examination of Lower Limbs
meducationdotnet
Rectal Examination
Rectal Examination
meducationdotnet
Male Genital Exam
Male Genital Exam
meducationdotnet
Obstetric Examination
Obstetric Examination
meducationdotnet
Respiratory Exam
Respiratory Exam
meducationdotnet
Basics of a Clinical Exam
Basics of a Clinical Exam
meducationdotnet
Opthalmoscopy
Opthalmoscopy
meducationdotnet
ECG Interpretation
ECG Interpretation
meducationdotnet
Coordination Exam
Coordination Exam
meducationdotnet
Venepuncture
Venepuncture
meducationdotnet
,motor examination
,motor examination
Pramod Mahender
Examination of a Swelling
Examination of a Swelling
meducationdotnet
Assessing the motor
Assessing the motor
Dr Magda Bayoumi
praetip ankle fracture
praetip ankle fracture
Nattapon Panupinthu
Apley's shoulderjt examination
Apley's shoulderjt examination
Dr. Manoj Parida
Apley's system of orthopaedics and fractures 9th ed
Apley's system of orthopaedics and fractures 9th ed
Khai Le Phuoc
physical examination of orthopaedic patient
physical examination of orthopaedic patient
yasser Amr
Similar a Muscle Power and Tone Examination
(20)
Musculoskeletal Exam
Musculoskeletal Exam
Breast Exam
Breast Exam
Continuation of Cranial Nerve Exam
Continuation of Cranial Nerve Exam
Examination of Lower Limbs
Examination of Lower Limbs
Rectal Examination
Rectal Examination
Male Genital Exam
Male Genital Exam
Obstetric Examination
Obstetric Examination
Respiratory Exam
Respiratory Exam
Basics of a Clinical Exam
Basics of a Clinical Exam
Opthalmoscopy
Opthalmoscopy
ECG Interpretation
ECG Interpretation
Coordination Exam
Coordination Exam
Venepuncture
Venepuncture
,motor examination
,motor examination
Examination of a Swelling
Examination of a Swelling
Assessing the motor
Assessing the motor
praetip ankle fracture
praetip ankle fracture
Apley's shoulderjt examination
Apley's shoulderjt examination
Apley's system of orthopaedics and fractures 9th ed
Apley's system of orthopaedics and fractures 9th ed
physical examination of orthopaedic patient
physical examination of orthopaedic patient
Más de meducationdotnet
No Title
No Title
meducationdotnet
Spondylarthropathy
Spondylarthropathy
meducationdotnet
Diagnosing Lung cancer
Diagnosing Lung cancer
meducationdotnet
Eczema Herpeticum
Eczema Herpeticum
meducationdotnet
The Vagus Nerve
The Vagus Nerve
meducationdotnet
Water and sanitation and their impact on health
Water and sanitation and their impact on health
meducationdotnet
The ethics of electives
The ethics of electives
meducationdotnet
Intro to Global Health
Intro to Global Health
meducationdotnet
WTO and Health
WTO and Health
meducationdotnet
Globalisation and Health
Globalisation and Health
meducationdotnet
Health Care Worker Migration
Health Care Worker Migration
meducationdotnet
International Institutions
International Institutions
meducationdotnet
Haemochromotosis brief overview
Haemochromotosis brief overview
meducationdotnet
Ascities overview
Ascities overview
meducationdotnet
Overview of the Liver
Overview of the Liver
meducationdotnet
Overview of Antidepressants
Overview of Antidepressants
meducationdotnet
Gout Presentation
Gout Presentation
meducationdotnet
Review of orthopaedic services: Prepared for the Auditor General for Scotland...
Review of orthopaedic services: Prepared for the Auditor General for Scotland...
meducationdotnet
Sugammadex - a revolution in anaesthesia?
Sugammadex - a revolution in anaesthesia?
meducationdotnet
Ophthamology Revision
Ophthamology Revision
meducationdotnet
Más de meducationdotnet
(20)
No Title
No Title
Spondylarthropathy
Spondylarthropathy
Diagnosing Lung cancer
Diagnosing Lung cancer
Eczema Herpeticum
Eczema Herpeticum
The Vagus Nerve
The Vagus Nerve
Water and sanitation and their impact on health
Water and sanitation and their impact on health
The ethics of electives
The ethics of electives
Intro to Global Health
Intro to Global Health
WTO and Health
WTO and Health
Globalisation and Health
Globalisation and Health
Health Care Worker Migration
Health Care Worker Migration
International Institutions
International Institutions
Haemochromotosis brief overview
Haemochromotosis brief overview
Ascities overview
Ascities overview
Overview of the Liver
Overview of the Liver
Overview of Antidepressants
Overview of Antidepressants
Gout Presentation
Gout Presentation
Review of orthopaedic services: Prepared for the Auditor General for Scotland...
Review of orthopaedic services: Prepared for the Auditor General for Scotland...
Sugammadex - a revolution in anaesthesia?
Sugammadex - a revolution in anaesthesia?
Ophthamology Revision
Ophthamology Revision
Muscle Power and Tone Examination
1.
Examination of the Motor
System In association with Dr David Smith Consultant Neurologist Walton Centre for Neurology and Neurosurgery 10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 110/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK
2.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Note This study guide is designed with right-handed examiners in mind. please substitute appropriately if left- handed Arrows on photographs depict the direction of movement of the limb
3.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 3 CONTENTS Tone and Clonus Limb Power Reflexes
4.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK The motor system Messages travel from the motor cortex via subcortical nuclei and brainstem to spinal cord, thence to nerve roots, peripheral nerves and finally to muscles Upper Motor Neurone (UMN) From the motor cortex to anterior horn cell of the spinal cord Lower Motor Neurone (LMN) from anterior horn cell to neuromuscular junction
5.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 5 Testing muscle tone and clonus
6.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Tone NORMAL passive movement of the limbs should be neither floppy nor stiff INCREASED due to - lesions of pyramidal tract (UMN) – SPASTICITY or lesions of the extrapyramidal tract – RIGIDITY REDUCED caused by LMN lesions, is called FLACCIDITY Abnormal tone will be accompanied by other signs which help to localise the lesion 10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 6
7.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 7 Testing for spasticity in the arms 1 Support the elbow with your left hand Hold patient’s hand as if shaking hands Rapidly supinate and pronate the arm Use the same technique on each arm Always use the same hand to assess movement for the patients right and left
8.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 8 Testing for spasticity in the arms 2 While still supporting the elbow passively flex and extend the elbow Use same technique on both arms If tone is normal there will be no resistance to these movements
9.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 9 Testing for spasticity in the legs 1 With the patient relaxed, place your hands on the thigh and roll the whole leg Observe the movement of the foot If tone is normal the range of movement of the foot is similar to the rotation of the leg Alternatively Flex and extend the knee If tone is normal there should be no resistance to this movement
10.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 10 Lower Limb Tone 2
11.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 11 Testing for spasticity in the legs 2 (Clonus) Position the patient with the knee flexed and the hip externally rotated Sharply dorsiflex the foot In most people with normal tone the foot will not move But 2-3 beats of clonus (plantar flexion followed by dorsiflexion of the foot) can be within normal limits Sustained clonus is a sign of an upper motor neurone problem
12.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Pyramidal tract (UMN) lesion; SPASTICITY There is initial resistance to movement which gives way as the movement continues Arm; SUPINATOR CATCH Leg; CLASP KNIFE phenomenon There is usually SUSTAINED CLONUS (>3-4 beats) 10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 12
13.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 13 Testing Power
14.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 14 The grading of muscle power (MRC) Grade Meaning 0 Complete paralysis 1 Flicker of contraction possible 2 Movement possible if gravity eliminated 3 Movement against gravity but not resistance 4 Movement possible against some resistance 5 Power normal (it is not normally possible to overcome a normal adult’s power) 6
15.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Patterns of weakness 1 Help to localise the problem within the nervous system A limited examination allows you to differentiate between UMN and LMN lesions Different patterns of LMN weakness may require more detailed examination 10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 15
16.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Motor power Ask the patient to make the required movement Attempt to overcome the movement remembering that this is not a test of relative strength Avoid mechanical advantage to the examiner 10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 16
17.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 17 Summary of motor supply to the upper limb Extension C7/8 Flexion C5/6 Extension C7/8 Flexion C6/7 Extension C7/8 Flexion C7/8 Abduction C5/6 Adduction C6/7/8 Adduction C8/T1
18.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 18 Shoulder abduction (C5/6) and adduction (C6/7/8) Position patient with shoulders abducted to 90° Ask patient to maintain position whilst you attempt to overcome by pressing down on upper arm Position patient with arms at approx 30° of abduction, with elbows flexed Ask patient to bring elbows towards side against resistance “Stop me pushing your arms down” “Stop me pushing your arms up”
19.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 19 Elbow flexion 2 (C5/6) and extension (C7/8) Position patient with elbow flexed Ask them to resist your attempt to straighten arm Position patient with elbow extended beyond 90 ° Ask them to resist your attempt to flex the elbow (‘push me away’) “Pull me towards you” “Push me away”
20.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 20 Finger extension (C7, C8) Position patient with fingers extended While supporting wrist ask them to resist your attempt to flex fingers “Stop me trying to bend your fingers down”
21.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Finger flexion Ask patient to curl fingers towards palm And to keep fingers flexed while you attempt to straighten them Alternatively ask them to squeeze two of your fingers placed in either of the patient’s palms 10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 21 “Stop me pulling your fingers straight” “Squeeze my fingers”
22.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 22 Summary of lower limb motor supply Abduction L4/5/S1 Adduction L2/3/4 Inversion L5/S1 Eversion L5/S1 Extension L3/4 Flexion L2/3Extension L5/S1/2 Dorsiflexion L4 Plantar flexion S1/S2 Flexion L5/S1
23.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 23 Hip flexion (L2/3) and extension (L5/S1/2) Position the patient with the leg elevated to approx 30° Attempt to overcome by pressing down on thigh Position patient with leg flat on couch Place your hand underneath thigh and attempt to elevate leg while patient presses down “Stop me trying to raise your leg up” “Stop me pushing your leg down”
24.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Knee flexion (L5/S1) Position patient seated with knee flexed Place your left hand on patient’s thigh Place your right hand behind heel/ankle/calf Ask patient to bring heel towards buttocks against resistance 10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 24 “Stop me trying to straighten your leg”
25.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Knee extension (L3/4) Position patient seated with knee flexed Place your left hand on patient’s thigh Place your right hand over patient’s shin Ask patient to straighten leg against resistance 10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 25 “Stop me trying to bend your knee”
26.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 26 Dorsiflexion (L4) and plantar flexion (S1/2) of the foot Dorsiflexion: Ask patient to bring foot upwards Attempt to overcome by pressing down on foot Plantar flexion: Ask patient to push foot down Attempt to overcome by pressing upwards on sole “Stop me pushing your foot down” “Stop me pushing your foot up”
27.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Patterns of weakness 2 UMN lesion there is weakness of the; extensors in the arms flexors in the legs The unopposed action of unaffected muscles produces the characteristic posture seen in patients with stroke LMN lesion involvement of nerve endings (peripheral neuropathy) produces a predominantly distal pattern of weakness 10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 27
28.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 28 Testing the reflexes
29.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 29 Reflexes Normal reflex arc requires :- Stimulus to stretch receptors Intact sensory afferent pathway Link with a motor unit Intact motor neurone Contractile element The order in which you test reflexes should be logical and may vary from one examiner to another The patient must be relaxed
30.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Documenting reflexes Absent - Present with reinforcement +/- Normal + or ++ Brisk +++ 10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 30 Reflexes can be recorded as follows:
31.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 31 The reflexes Biceps (C5/6) Triceps (C7/8) Supinator (C5/6) Finger (C8) Ankle (S1/2) Plantar (L5/S1/2) Knee (L3/4) Abdominal
32.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Testing for reflexes Position the limb correctly Hold the tendon hammer like a hammer Place your finger over the tendon and strike it, for some reflexes you will strike the tendon itself (see slides below) (except the ankle – see slide 38) Observe the relevant muscle for contraction (not the limb movement) Be aware of the range of normality. Abnormal reflexes rarely seen without other relevant signs10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 32
33.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 33 Reinforcement Where a reflex appears difficult to elicit, reinforcement might be tried. Ask the patient to close their eyes: lower limb ask the patient to grasp the fingers of each hand and to pull apart on instruction just as the reflex is tested upper limb the teeth may be clenched Reinforcement for a lower limb reflex – with patient’s eyes closed
34.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 34 The upper limb Reflex Testing
35.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 35 Supinator (brachioradialis) reflex (C5/6) Position patient sitting relaxed, with elbows flexed and hands resting on thigh/groin Place your left index/middle finger(s) over supinator tendon Strike finger(s) with falling head of hammer Observe slight elbow flexion or contraction of belly of brachioradialis Observe for contraction of brachioradialis here You may notice momentary elbow flexion
36.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 36 Biceps reflex (C5/6) In same position clasp patient’s elbow so that biceps tendon can be felt under your thumb or finger Strike your thumb or finger Observe elbow flexion there may be little movement but you should feel the contraction
37.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 37 Triceps reflex (C7/8) Position patient with their arm across the abdomen with elbow flexed to 90° Strike the triceps tendon direct Observe for elbow extension or contraction of the muscle bellyYou may feel muscle contract with free hand
38.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 38 The finger jerk (C8) Ask patient to rest their fingers on index and middle fingers of your left hand and curl their fingers slightly Strike your fingers Patient’s fingers may flex This can be normal
39.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 39 The lower limb Reflex Testing
40.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 40 Knee reflex (L3/4) Support one or both knees, so they are slightly bent Strike the patellar tendon direct Observe quadriceps contraction with or without knee extension Infrapatellar ligament Patella
41.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 41 Ankle reflex S1/2 Patient is seated Place your left hand on ball of patient's foot Passively dorsiflex the ankle Strike your fingers Observe/feel for plantarflexion
42.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 42 Plantar reflex (L5/S1/2) Patient seated with leg flat on couch Drag thumbnail or blunt object along the lateral border of the foot and across the sole towards other side The normal response is flexion of the big toe may be absent if feet are cold
43.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Patterns of reflex change UMN lesion Reflexes brisk below the level of the lesion plantar response is usually extensor A pathologically brisk finger flexion jerk is the upper limb equivalent of an extensor plantar response LMN lesion (peripheral neuropathy) reflexes are absent distal reflexes are first to be lost 10/13/2011 43
44.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Summary Parameter UMN lesion LMN lesion (peripheral neuropathy)* Posture Flexed UL, Extended LL May be wasting, fasciculation Tone Increased (spasticity) Reduced (flaccidity) Power Weakness of UL extensors and LL flexors Distal weakness Reflexes Brisk Absent Plantar response Extensor Flexor or absent 10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 44 There are other patterns of lower motor neurone lesions (nerve root, individual peripheral nerve). *
45.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Reminder What you have learned so far will allow you to distinguish between UMN and LMN lesions In future you will learn additional skills needed to localise lesions according to particular presentations E.g. examination of the intrinsic hand muscles in someone with weakness or tingling in the hand/fingers. 10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 45
46.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Finger abduction Support patient’s wrist with your left hand Ask patient to spread fingers wide Ask patient to maintain this position while you try to push little finger inwards Ask patient to maintain this position while you try to push index finger inwards 10/13/2011 46 “Stop me pushing your fingers”
47.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Thumb abduction (T1, median) Support patient’s wrist with your left hand Ask patient to lift thumb upwards Ask them to maintain that position against resistance 10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 47 “Stop me pushing your thumb down to your palm” Thumb abduction is 90° to finger abduction
48.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Thumb opposition (T1,Median) Support patient’s wrist with left hand Ask patient to place tip of thumb onto tip of index finger And to hold this position while you try to separate the thumb and index finger 48 “Stop me pulling your fingers apart”
49.
10/13/2011 © Clinical
Skills Resource Centre, University of Liverpool, UK Thumb adduction (T1, Ulnar) Support patient’s wrist with your left hand Ask patient to trap your index and middle fingers between the base of their thumb and their index finger Ask them to maintain that position while you try to lift their thumb 10/13/2011 49 “Stop me trying to lift your thumb up”
Descargar ahora