SEu, caps 7, day 2-3 motor system exam (1).pptx

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1. SEU, clinical and Professional skill s , semester VII, Day 2-3 , motor system exam Pronator drift; Muscle tone, bulk, strength

2. Testing of Motor Function observations of the speed and strength of movements and of muscle bulk, tone, and coordination and these are considered in the context of the state of tendon reflexes. The maintenance of the supinated arms against gravity is a useful test; the weak arm, tiring first , soon begins to sag, or , in the case of a corticospinal lesion , to resume the more natural pronated position (" pronator drift ").

3. Pronator drift test Pronator drift indicates  abnormal function of the corticospinal tract in the contralateral hemisphere . In some patients, the arm may remain supinated but drop lower than the unaffected arm, and the fingers and elbow might flex . To assess for pronator drift, explain to your patient what he or she needs to do. Depending on the patient's condition, ask him or her to stand or sit .   Ask the patient to close his or her eyes, then to stretch out both arms with the palms facing up . Have the patient hold arms out horizontally, palms up, with eyes closed. If there is upper limb weakness, the affected side will "drift" or pronate within 30 seconds. With the patient lying in a supine position, bend the knees to 30 degrees.

4. Testing of Motor Function perform simple tasks, such as alternately touching his nose and the examiner 's finger ; make rapid alternating movements that necessitate sudden acceleration and deceleration and changes in direction, such as tapping one hand on the other while alternating pronation and supination of the forearm; rapidly touch the thumb to each fingertip ; and accomplish simple tasks such as buttoning clothes, opening a safety pin, or handling common tools.

5. Grading muscle strength = no observable contraction. 1 = slight contraction, but no movement. 2 = full range of motion, but not against gravity. 3 = full range of motion against gravity. 4 = full range of motion against some resistance . 5 = full range of motion against full resistance.

6. Muscle tone Muscle TONE is defined as the tension in a muscle at rest . It is the muscle’s response to an outside force, such as a stretch or change in direction. Appropriate muscle tone enables our bodies to quickly respond to a stretch. For example, if someone took your arm and quickly straightened your elbow, your biceps muscle would automatically respond and contract in response to protect you from injury.

7. Muscle tone Muscle tone is  assessed by asking the patient to relax completely while the examiner moves each joint through the full range of flexion and extension . Patients vary in their ability to relax . Normal tone means that there is the right amount of “tension” inside the muscle at rest, and that  the muscle is inherently able to contract on command . Put simply, you can “tell” your muscle to stop and start and it does what you want, when you want, with the appropriate amount of force.

8. Hypertonia Hypertonia is resistance to passive movement , it is not dependent on velocity, can be with or without spasticity. Spasticity is  an increase in resistance to sudden , passive movement  and IS velocity dependent.

9. H ypotonia : floppy infant A child with low tone, or  HYPOTONIA , has muscles that are slower to react to a stretch and are unable to sustain a prolonged muscle contraction . If a hypotonic child’s arm was stretched quickly, the same way as above, there would be minimal to no response of their biceps muscle . Sometimes the muscles of a child with low tone may feel soft and mushy or they may appear “floppy ”.

10. Strength testing    In the upper extremities, test: shoulder abduction, elbow extension, elbow flexion, wrist extension, wrist flexion , finger extension, finger flexion, finger abduction. In the lower extremities, test : hip flexion, hip extension, knee flexion, knee extension, ankle dorsiflexion, ankle plantar flexion. Additional testing may be necessary if some of these muscles are weak or if the patient complains of focal weakness to determine if the weakness is in the distribution of a specific nerve or nerve root.

11. Shoulder abduction Ask the patient to lift both his elbows out to the side ( demonstrate ). Ask him to push up • Muscle : deltoid • Nerve : axillary nerve • Root : C5.

12. Elbow flexion Hold the patient's elbow and wrist. Ask him to pull his hand towards his face . N.B. Ensure the arm is supinated • Muscle : biceps brachii • Nerve : musculocutaneous nerve • Root : C5, C6. Elbow extension Hold the patient's elbow and wrist . Ask him to extend the elbow • Muscle : triceps • Nerve : radial nerve • Root : (C6), C7, (C8).

13. Test flexion (C5, C6—biceps ) and extension (C6, C7, C8—triceps) at the elbow by having the patient pull and push against your hand.

14. Wrist extension Hold the patient's forearm. Ask him to make a fist and bend his wrist up • Muscle : flexor carpi ulnaris and radialis • Nerve : radial nerve • Root : (C6), C7, (C8).

15. Finger extension Fix the patient's hand. Ask him to keep his fingers straight . Press against the extended fingers • Muscle : extensor digitorum • Nerve : posterior interosseous nerve (a branch of the radial nerve) • Root : C7, (C8).

16. Finger flexion Close your fingers on the patient's fingers palm to palm so that both sets of fingertips are on the other's metacarpal phalangeal joints. Ask the patient to grip your fingers and then attempt to open the patient's grip Muscles : flexor digitorum superficialis and profundus • Nerves : median and ulnar nerves • Root : C8.

17. Finger abduction Ask the patient to spread his fingers out ( demonstrate ). Ensure the palm is in line with the fingers . Hold the middle of the little fingers and attempt to overcome the index. • Muscle : first dorsal interosseous • Nerve : ulnar nerve • Root : T1.

18. Finger adduction Ask the patient to bring his fingers together. Make sure the fingers are straight . Fix the middle, ring and little fingers. Attempt to abduct the index finger. • Muscle : second palmar interosseous • Nerve : ulnar nerve • Root : T1. Thumb abduction Ask the patient to place his palm flat with a supinated arm . Ask him then to bring his thumb towards his nose . Fix the palm and, pressing at the end of the proximal phalanx joint, attempt to overcome the resistance . • Muscle : abductor pollicis brevis • Nerve : median • Root : T1.

19. Test opposition of the thumb (C8, T1, median nerve). The patient should try to touch the tip of the little finger with the thumb, against your resistance.

20. Serratus anterior Stand behind the patient in front of a wall . Ask him to push against the wall with his arms straight and his hands at shoulder level. Look at the position of the scapula. If the muscle is weak, the scapula lifts off the chest wall: ‘winging ’ • Nerve : long thoracic nerve • Root : C5, C6, C7. Video

21. Rhomboids Ask the patient to put his hands on his hips. Hold his elbow and ask him to bring his elbow backwards. • Muscle : rhomboids • Nerve : nerve to rhomboids • Root : C4, C5. Video

22. Supraspinatus Stand behind the patient. Ask the patient to lift his arm from the side against resistance. • Nerve : suprascapular nerve • Root : C5. Video

23. Infraspinatus Stand behind the patient, hold his elbow against his side with the elbow flexed, asking him to keep his elbow in and move his hand out to the side . Resist this with your hand at his wrist. • Nerve : suprascapular nerve • Root : C5, C6. Video

24. Brachioradialis Hold the patient's forearm and wrist with the forearm semi-pronated ( as if shaking hands ). Ask the patient to pull his hand towards his face • Muscle : brachioradialis • Nerve : radial nerve • Root : C6. Video

25. Long flexors of little and ring finger Ask the patient to grip your fingers . Attempt to extend the distal interphalangeal joint of the little and ring fingers. • Muscle : flexor digitorum profundus 3 and 4 • Nerve : ulnar nerve • Root : C8.

26. Hip flexion Ask the patient to lift his knee towards his chest . When the knee is at 90 degrees, ask him to pull it up as hard as he can; put your hand against his knee and try to overcome this • Muscle : iliopsoas • Nerve : lumbar sacral plexus • Root : L1, L2. flexion at the hip (L2, L3, L4—iliopsoas) by placing your hand on the patient’s thigh and asking the patient to raise the leg against your hand.

27. Hip extension The patient is lying flat with his legs straight . Put your hand under his heel and ask him to push down to press your hand. • Muscle : gluteus maximus • Nerve : inferior gluteal nerve • Root : L5, S1.

28. Knee extension Ask the patient to bend his knee . When it is flexed at 90 degrees, support the knee with one hand and place the other hand at his ankle and ask him to straighten his leg • Muscle : quadriceps femoris • Nerve : femoral nerve • Root : L3, L4. Test extension at the knee (L2, L3, L4—quadriceps ). Support the knee in flexion and ask the patient to straighten the leg against your hand . The quadriceps is the strongest muscle in the body, so expect a forceful response .

29. Knee flexion Ask the patient to bend his knee and bring his heel towards his bottom. When the knee is at 90 degrees, try to straighten the leg while holding the knee . Watch the hamstring muscles • Muscles : hamstrings • Nerve : sciatic nerve • Root : L5, S1. Test flexion at the knee (L4, L 5 , S1, S2—hamstrings) as shown below. Place the patient’s leg so that the knee is flexed with the foot resting on the bed. Tell the patient to keep the foot down as you try to straighten the leg.

30. Foot dorsiflexion Ask the patient to cock his ankle back and bring his toes towards his head. When the ankle is past 90 degrees, try to overcome this movement. Watch the anterior compartment of the leg • Muscle : tibialis anterior • Nerve : deep peroneal nerve • Root : L4, L5. Test dorsiflexion (mainl y L4, L5) and plantar flexion (mainly S1) at the ankle by asking the patient to pull up and push down against your hand.

31. Plantar flexion of the foot Ask the patient to point his toes with his leg straight. Try to overcome this • Muscle : gastrocnemius • Nerve : posterior tibial nerve • Root : S1.

32. Big toe extension Ask the patient to pull his big toe up towards his face . Try to push the distal phalanx of his big toe down • Muscle : extensor hallucis longus • Nerve : deep peroneal nerve • Root : L5.

33. Resisted hip abduction allows the examiner to assess the strength of the patient's hip abductors, particularly the gluteus medius . Resisted hip abduction Hip abductors Fix one ankle ; ask the patient to push the other leg out at the side and resist this movement by holding the other ankle. • Muscle : gluteus medius and minimus • Nerve : superior gluteal nerve • Root : L4, L5.

34. Hip adduction against resistance Adduction against resistance is an important test of hip adductor muscle function. Hip adductors Ask the patient to keep his ankles together. Fix one ankle and try to pull the other ankle out • Muscle : adductors • Nerve : obturator nerve • Root : L2, L3.

35. Functional assessment of the iliopsoas muscle Iliopsoas function can be tested grossly by having the patient flex their hip against resistance.

36. Concentric hamstring strength testing Both concentric and eccentric strength should be part of the hamstring examination. Concentric strength testing begins with the knee bent at 90 degrees.

37. Foot inversion With the ankle at 90 degrees, ask the patient to turn his foot inwards. This frequently requires demonstration • Muscle : tibialis posterior • Nerve : tibial nerve • Root : L4, L5.

38. Foot eversion Ask the patient to turn his foot out to the side. Then try to bring the foot to the midline • Muscle : peroneus longus and brevis • Nerve : superficial peroneal nerve • Root : L5, S1.

39. muscle bulk and symmetry: Normally , the size and contour of muscles are symmetrical from one side of the body to the other. In addition, muscle bulk should be symmetrical between proximal and distal locations. Muscles may be diminished in bulk (atrophied) or increased in bulk (hypertrophic). When there is a discrepancy in muscle bulk, note whether the process is unilateral or bilateral, and whether proximal or distal muscles are affected preferentially.

40. Testing of Motor Function It is essential to have the limbs exposed and to inspect them for atrophy and fasciculations . Abnormalities of movement and posture as well as tremors may be revealed by observing the limbs at rest and in motion

41. A trophy : Atrophy , or wasting, refers to the loss of muscle bulk . Evaluate the muscles of the hands, shoulders, and thighs. Comparing one side of the body to the other is an easy way to note differences in muscle bulk, although many diseases lead to bilateral muscle wasting. Atrophy results from diseases of the muscles themselves (for example, muscular dystrophy) or disease of peripheral nerves (such as diabetic neuropathy ). , as may occur with any serious illness, may be associated Prolonged inactivity with generalized muscle atrophy. Atrophy of the hand muscles usually indicates a nerve compression syndrome . If the thenar eminence is atrophied, it can be due to median nerve compression (carpal tunnel syndrome is a common cause ), and if the hypothenar eminence is atrophied, ulnar nerve compression may be the cause.