Motor Examination

Motor ExaminationCreated OnJune 2, 2020Last Updated OnJune 2, 2020byadmin You are here: Main Clinical Examination Motor Examination < All Topics Table of Contents Basic Neuroanatomy of the motor function: Pyramidal tracts – corticospinal tract Decussation takes place at the medulla. Introduction: Introduce yourself and confirm the patient’s identity. Explain the examination to the patient. Gain consent. Wash hand and get a chaperone if the patient requests for one. Inspection: Expose patient adequately while keeping patient comfort Observe for asymmetry, inspect both proximally and distally Examine for wasting/hypertrophy, fasciculation and involuntary movement Tone: Upper Limb Hold patient’s hand as if shaking hands, use your other hand to support the elbow. Assess the tone at the wrist and elbow Look for resistance that is decreased (hypotonia) or increased (hypertonia) throughout range of motion. Lower Limb With patient lying down with legs relaxed Roll patient’s leg from side to side, observe the movement of the foot Normally, the heel will move up the bed but increased tone will cause it to lift off the bed. Clonus: Clonus occurs when there are sustained rhythmical contraction of muscles after a sudden stretch. It signifies the hypertonia of an upper motor neuron lesion. To elicit patella clonus: Lie the patient down in supine position with the knees and hips extended. Hold the patient’s patella between the thumb and index finger while resting the remaining part of the hand on the quadriceps. Sharply pull down the patella If clonus is present, there will be sustained rhythmical contraction of quadriceps as long as the downward pressure on the patella is maintained. To elicit ankle clonus: Support patient’s leg with both knee and ankle resting in 90˚ fashion Brisk dorsiflex the foot and sustaining the pressure. Clonus is felt as repeated beats of dorsiflexion/plantar flexion Deep tendon reflexes: Ask patient to lie supine on the couch with limb adequately exposed Patient need to be relaxed and comfortable as possible. Flex your wrist and allow the weight of the tendon hammer head to determine the strength of the blow. Strike the tendon. Biceps reflex Patient arm should be partially flexed at the elbow with palm down Place your thumb or finger firmly on biceps tendon Strike your thumb with the tendon hammer You should feel the response even you can’t see it. Triceps jerk With patient lying down, flex arm at the elbow and hold it close to chest Strike the triceps tendon above the elbow Hoffmann’s reflex Place your index finger under the distal interphalangeal joint of the patient’s middle finger Flick patient’s finger downward using your thumb. Observe for any reflex flexion of the patient’s thumb Finger jerk Place own middle and index fingers across the palmar surface of the patient’s proximal phalanges Strike your own fingers with the hammer Watch for flexion of the patient’s finger. Knee Reflex Have patient to sit or lie down with knee flexed Strike patellar tendon...

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