Neurological Examination of Limb

Neurological Examination of Limb

1. Upper Limb

   • Introduction
   • Inspection
     • posture & symmetry
     • symmetry, size & shape of muscles
     • scars & bruising
     • abnormal movements
       • athetosis
       • dystonia
       • intention tremor
     • fasciculation
   • Assessment of Tone
     • ask patient to relax arm
     • put each major joint through a full range of movement
   • Assessment of Power
     • shoulder abduction
     • Elbow
       • Flexion
       • Extension
     • Finger
       • Flexion
       • Abduction
       • Adduction
     • Thumb abduction
     • Scoring System
       • 0 no movement
       • 1 muscle belly moves but joint does not move
       • 2 Joint moves with gravity eliminated
       • 3 Joint moves against gravity
       • 4 joint moves against gravity & resistance
       • 5 Full strength
   • Tendon Reflexes
     • Biceps C6
     • Triceps C7
     • Brachoradialis C6
     • Jendrassik's maneuvre
   • Sensation
     • Dorsal Column
       • vibration
       • Proprioception
       • Light touch
       • 2 point discrimination
     • Spinothalamic
       • Pain
       • Temperature
       • some light touch
   • Coordination
     • finger-nose
     • finger-finger
       • tremor & overshooting
     • Alternating hand movements
       • dysdiadochokinesia
     • Fine movement
     • Cerebellar drift (rebound)
   • Conclusion

2. Lower Limb

   • Inspection
     • Muscle Wasting
     • Asymmetry
     • Fasciculation
   • Tone
     • ankle clonus
     • roll leg on bed to assess ease of movement
     • pull up on knee
   • Power
     • hip flexion
     • hip extension
     • knee flexion
     • knee extension
     • dorsiflexion
     • Plantarflexion
     • Toe Plantarflexion
     • Toe Dorsiflexion
   • Reflexes
     • Patellar
     • ankle
     • plantar
   • Function
     • Romberg's test
   • Sensation
     • Dorsal Column
       • Vibration
       • Proprioception
       • Discriminative Touch
     • Spinothalamic
       • Pain
       • Temperature
       • Non-discriminative light touch

3. Elements that need to be intact

   • Brain
   • Spinal Cord
   • Peripheral Nervous System
   • Muscles
   • Tendons & Attachments
   • Bone

4. Method

   • Inspection
   • Palpation
   • Auscultation
   • Percussion

5. Comparison

   • Left to Right
   • Proximal to distal
   • Upper & Lower Motor Neurone lesions

6. Test for

   • Tone
   • Power
   • Reflexes
   • Sensation
   • Coordination