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Upper
extremities – Inspection and Palpation
The muscles are inspected for bulk and fasciculations and, when indicated,
palpated for tenderness, consistency and contractures. |
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Tone
Muscle tone is assessed by putting selected muscle groups through passive
range of motion. The most commonly used maneuvers for the upper extremities
are flexion and extension at the elbow and wrist. |
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Strength testing
Muscle strength is tested from the proximal to the distal part of the
extremity so that all segmental levels for the extremity are tested (for
the upper extremity that is C5 to T1 – see table). Muscle power is graded
on a scale of 0-5 (see table)
Strength
Testing
C5 – Shoulder
extension
C6 – Arm flexion
C7 – Arm extension
C8 – Wrist extensors
T1 – Hand grasp
Muscle
Strength Grading
0 – No contraction
1 – Slight contraction, no movement
2 – Full range of motion without gravity
3 – Full range of motion with gravity
4 – Full range of motion , some resistance
5 – Full
range of motion, full resistance
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Stretch or Deep
Tendon Reflexes
A brisk tap to the muscle tendon using a reflex hammer produces a stretch
to the muscle that results in a reflex contraction of the muscle. The
muscles tested, segmental level, and grading of DTR's is listed below.
Levels
for DTR's
Biceps – C5-6
Brachioradialis – C5-6
Triceps – C7
Finger Flexors
– C8
Grading
DTR's
0 – Absent
1 – Decreased but present
2 – Normal
3 – Brisk and excessive
4 – With clonus
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Testing
for pronator drift
The patient extends their arms in front of them with the palms up and eyes
closed. The examiner watches for any pronation and downward drift of either
arm. If there is pronator drift this indicates corticospinal tract disease. |
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Lower
extremities – Inspection and Palpation
The muscles are inspected for bulk and fasciculations and, when indicated,
palpated for tenderness, consistency and contractures. |
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Tone
Muscle tone is assessed by putting selected muscle groups through passive
range of motion. The most commonly used maneuvers for the lower extremities
are flexion and extension at the knee and ankle. |
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Strength testing
Muscle strength is tested from the proximal to the distal part of the
extremity so that all segmental levels for the extremity are tested (for
the lower extremity that is L2 to S1 – see table). Muscle power is graded
on a scale of 0-5 (see table)
Strength
Testing
L2 – Hip flexion
L3 – Knee extension
L4 – Knee flexion
L5 – Ankle dorsiflexon
S1 – Ankle plantar flexion
Muscle
Strength Grading
0 – No contraction
1 – Slight contraction, no movement
2 – Full range of motion without gravity
3 – Full range of motion with gravity
4 – Full range of motion, some resistance
5 – Full range of motion, full resistance
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Stretch or Deep
Tendon Reflexes
A brisk tap to the muscle tendon using a reflex hammer produces a stretch
to the muscle that results in a reflex contraction of the muscle. The
muscles tested, segmental level, and grading of DTR's is listed below.
Levels
for DTR's
Patellar or Knee –
L2-4
Ankle – S1-2
Grading
DTR's
0 – Absent
1 – Decreased but present
2 – Normal
3 – Brisk and excessive
4 – With clonus
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Plantar Reflex
The plantar reflex is a superficial reflex obtained by stroking the skin
on the lateral edge of the sole of the foot, starting at the heel advancing
to the ball of the foot then continuing medially to the base of the great
toe. The normal response is flexion of all the toes. The abnormal response
is called a Babinski sign and consists of extension of the great
toe and fanning of the rest of the toes.
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Pathological reflexes-
frontal release signs- snout, root, palmomental
These patterned behavior reflexes appear when there is damage to the frontal
lobes, which inhibits these primitive reflexes. In the normal person these
reflexes are absent.
Pressing a tongue blade on the lips tests for the snout reflex.
The abnormal response is a pouting of the lips.
The root reflex is tested for by gently stroking the lateral upper
lip. The abnormal response is movement of the mouth towards the stimuli.
Stroking the palm of the hand while watching for contraction of the ipsilateral
mentalis muscle of the lower lip tests for the palmomental reflex.
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Strength testing
using squat & rise, heel & toe
The strength of the powerful muscles of the lower extremities is often
best assessed by using the patient's own weight. Having the patient squat
and rise tests the pelvic girdle and upper leg muscles while heel and
toe walking tests the muscles of the foreleg.
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Home (Exam)
MOVIES
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