Limbs motor Examination of motor function is divided into: position and posture muscle inspection tone power testing tendon reflexes and plantar response. As with all parts of the examination, attention needs to be paid to the hypotheses thrown up by the history. Position and posture Patients with different types of motor disease assume typical positions. It is worth looking at the position of the patient before examining the limbs at closer quarters. For example, a patient whose arm is held with a flexed elbow, wrist and fingers and whose leg is extended at the knee and ankle has a contralateral hemisphere lesion, typically a stroke. The myasthenic patient has an extended neck to overcome the ptosis, and a droopy jaw. The patient with Parkinson’s disease is stooped with flexed elbows. Muscle inspection Look at the bulk of the muscles. Is the bulk normal, decreased (atrophied) or increased (hypertrophied)? Muscle atrophy is most commonly seen distally in the small muscles of the hands and in the feet and tibialis anterior. Muscle atrophy can be confined to one muscle group or be more generalized. Atrophy usually reflects lower motor neurone abnormalities, though muscles do atrophy from disuse, for example in a longstanding upper motor neurone lesion or with severe muscle disease. Muscle hypertrophy is much rarer than atrophy. The calves are most commonly affected. This is seen in the Duchenne and Becker muscular dystrophies. Fasciculations are small movements within the muscle and reflect contraction of a motor unit. These usually indicate a lower motor neurone abnormality. They are widespread in anterior horn cell diseases, typically motor neurone disease. They can occur in the absence of neurological disease, and are quite commonly observed in the calves of people without neurological disease. Tone This is usually assessed at the wrist, elbow, hip and knee (Fig. 1). The joint is moved through its range, initially slowly and then at increasing speeds. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: CNS neoplasia I: Intracranial tumours Parkinson’s disease and other akinetic rigid syndromes II Head injury Blackouts and ‘funny do’s’ Giddiness Walking difficulties and clumsiness Stay updated, free articles. Join our Telegram channel Join Tags: Neurology An Illustrated Colour Text Jun 10, 2016 | Posted by admin in NEUROLOGY | Comments Off on Limbs: motor Full access? Get Clinical Tree
Limbs motor Examination of motor function is divided into: position and posture muscle inspection tone power testing tendon reflexes and plantar response. As with all parts of the examination, attention needs to be paid to the hypotheses thrown up by the history. Position and posture Patients with different types of motor disease assume typical positions. It is worth looking at the position of the patient before examining the limbs at closer quarters. For example, a patient whose arm is held with a flexed elbow, wrist and fingers and whose leg is extended at the knee and ankle has a contralateral hemisphere lesion, typically a stroke. The myasthenic patient has an extended neck to overcome the ptosis, and a droopy jaw. The patient with Parkinson’s disease is stooped with flexed elbows. Muscle inspection Look at the bulk of the muscles. Is the bulk normal, decreased (atrophied) or increased (hypertrophied)? Muscle atrophy is most commonly seen distally in the small muscles of the hands and in the feet and tibialis anterior. Muscle atrophy can be confined to one muscle group or be more generalized. Atrophy usually reflects lower motor neurone abnormalities, though muscles do atrophy from disuse, for example in a longstanding upper motor neurone lesion or with severe muscle disease. Muscle hypertrophy is much rarer than atrophy. The calves are most commonly affected. This is seen in the Duchenne and Becker muscular dystrophies. Fasciculations are small movements within the muscle and reflect contraction of a motor unit. These usually indicate a lower motor neurone abnormality. They are widespread in anterior horn cell diseases, typically motor neurone disease. They can occur in the absence of neurological disease, and are quite commonly observed in the calves of people without neurological disease. Tone This is usually assessed at the wrist, elbow, hip and knee (Fig. 1). The joint is moved through its range, initially slowly and then at increasing speeds. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: CNS neoplasia I: Intracranial tumours Parkinson’s disease and other akinetic rigid syndromes II Head injury Blackouts and ‘funny do’s’ Giddiness Walking difficulties and clumsiness Stay updated, free articles. Join our Telegram channel Join Tags: Neurology An Illustrated Colour Text Jun 10, 2016 | Posted by admin in NEUROLOGY | Comments Off on Limbs: motor Full access? Get Clinical Tree
