1. Ask: pain?

Gait
1. Stand on tip toes: distal muscle weakness diagnosed
2. Heel-toe walking: cerebellar function
3. Shuffling: Parkinsonism
4. Stamping: loss of sensation
5. Stand feet together, arms out; close eyes. Push arms down; side of lesion overshoots when returning to base position. Confirms sensory cause of ataxia: proprioception deficit due to dorsal column defect: rather than cerebellar cause of ataxia. (Rhomberg’s test)
Back inspection
1. Scars
2. Tumours
End of bed:
1. Scars
2. Asymmetry and atrophy
3. Fasciculations: flick muscles
Tone
1. Log roll
2. Lift at knee and heel: move knee, roll heel, jerk heel - clonus
3. Jerk up from thigh: knee bends?
Power
1. Hips (flexion, extension, adduction, abduction)
2. Knees (flexion, extension)
3. Ankles (flexion, extension, eversion, inversion)
Coordination
1. Tap bed
2. Run ankle along shin
Reflexes
1. Knee jerk (L3-4), Achilles tendon (S1), Plantar response (S1-2)
Sensation: fine touch, pain, vibration (128 Hz tuning fork), proprioception
1. Compare to sternum, and side to side
2. Dermatomes:
  1. Anterior thigh: L2
  2. Anterior knee: L3
  3. Medial calf: L4
  4. Lateral calf, dorsum of foot: L5
  5. Lateral foot: S1
Further tests:
1. Neurological examination of upper limb
2. Confirm cerebellar problems with nystagmus test
3. Abdominal reflexes (T8-12)

Upper versus lower motor neurone lesions:

UMN:

LMN:

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by: Admin
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Word Count: 596
Date: Fri, 22 Jan 2010 Time: 3:59 PM
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