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Upper vs. lower motor neuron lesions

2009-02-08T00:13:27Z

67.142.235.68: /* Inspection */

==Inspection==
MOSTLY SEEN IN SPINAL CORD INJURY
===Muscle Bulk===
*loss of muscle bulk in LMN and late in UMN
*symmetry
Muscle grith

===Fasciculations===
*present in LMN, none in UMN

==Muscle Tone==
*flexion/extension, pronation/supination of joint through its ROM
===Hypotonia===
**flaccidity
**LMN lesions, spinal shock, cerebellar lesions
===Hypertonia===
*'''Spasticity''' - UMN lesion. Pyramidal tract involved
*limb moves, then catches, and then goes past catch ('''clasp-knife''')
**test by rapidly supinating forearm
*'''Rigidity'''
**UMN lesions, extrapyrimidal tract lesion
**increased tone throughout ROM (cog-wheeling, lead-pipe)
**circumducting the wrist

==Power==
*UMN
**flexors > extensors in upper limbs
**extensors > flexors in lower limbs
*LMN
**reduced power in specific motor neuron distribution
***deltoids - arm abduction - C5 C6 (axillary)
***biceps - elbow flexion - C5 C6 (musculocutaneous)
***triceps - elbow extension - C6 C7 C8 (radial)
***thumb flexion - C6 C7 (median)
***wrist extensors - C7 C8 (radial)
***interossei of hand - finger abduction/adduction - C8 T1 (ulnar)
***hip flexion - L1 L2 L3 (femoral)
***hip adduction - L2 L3 L4 (obturator)
***hip abduction - L4 L5 S1 (superior gluteal)
***knee extension - L2 L3 L4 (femoral)
***knee flexion - L5 S1 S2 (sciatic)
***ankle dorsiflexion - L4 L5 (deep peroneal)
***ankle plantar flexion - S1 S2 (tibial)
***foot inversion - L4 L5 (posterior tibial)
***foot eversion - L5 S1 (superficial peroneal)
* compare between L and R

* GRADE
**0 nil
**1 flicker of movement
**2 movement cannot overcome gravity
**3 movement cannot overcome any resistance
**4 movement is weaker than normal
**5 normal

==Special Tests==
===Pronator Drift===
*have the patient stand with eyes closed and arms held straight out and hands supinated
* + → patient cannot maintain this position
**muscle weakness (pronation and outward drift)
**UMN lesion (pronation and downward drift)

===Fine Finger Movements===
*ask patient to touch each finger to crease of thumb (show patient how) and speed it up
*look for right and left differences, slow if UMN lesion

===Clonus===
*Ankle or Patellaer clonus in UMN Lesion

==Reflexes==
===Dorsal Tendon Reflexes===
*biceps tendon (C5-6)
*brachioradialis tendon (C5-6)
*triceps tendon (C6-8)
*knee jerk (L2-4)
*Achilles tendon (S1-2)

*hyperactive ankle jerk → examine for clonus at knee and ankle
*absent → use reinforcements (teeth clenching for UL, Jendrassik’s maneuver for LL)

*UMN → hyperreflexia, but may be flaccid
*LMN → diminished reflexes

===Grading===
*0 nil
*1 low normal
*2 normal
*3 high normal
*4 clonus (sustained > 3 beats)

* note if reinforcements used (teeth clenching, hand grips)

===Babinski’s reflex (L5-S1)===
* + → dorsiflexion of the big toe with/without fanning of the other toes (UMN lesion)
GROSS MOTOR

==Other OSCE Modules==
{{OSCE2}}
[[Category: Neurology]][[Category:OSCE]]

Upper vs. lower motor neuron lesions

2009-02-08T00:12:28Z

67.142.235.68: /* Babinski’s reflex (L5-S1) */

==Inspection==

===Muscle Bulk===
*loss of muscle bulk in LMN and late in UMN
*symmetry
Muscle grith

===Fasciculations===
*present in LMN, none in UMN

==Muscle Tone==
*flexion/extension, pronation/supination of joint through its ROM
===Hypotonia===
**flaccidity
**LMN lesions, spinal shock, cerebellar lesions
===Hypertonia===
*'''Spasticity''' - UMN lesion. Pyramidal tract involved
*limb moves, then catches, and then goes past catch ('''clasp-knife''')
**test by rapidly supinating forearm
*'''Rigidity'''
**UMN lesions, extrapyrimidal tract lesion
**increased tone throughout ROM (cog-wheeling, lead-pipe)
**circumducting the wrist

==Power==
*UMN
**flexors > extensors in upper limbs
**extensors > flexors in lower limbs
*LMN
**reduced power in specific motor neuron distribution
***deltoids - arm abduction - C5 C6 (axillary)
***biceps - elbow flexion - C5 C6 (musculocutaneous)
***triceps - elbow extension - C6 C7 C8 (radial)
***thumb flexion - C6 C7 (median)
***wrist extensors - C7 C8 (radial)
***interossei of hand - finger abduction/adduction - C8 T1 (ulnar)
***hip flexion - L1 L2 L3 (femoral)
***hip adduction - L2 L3 L4 (obturator)
***hip abduction - L4 L5 S1 (superior gluteal)
***knee extension - L2 L3 L4 (femoral)
***knee flexion - L5 S1 S2 (sciatic)
***ankle dorsiflexion - L4 L5 (deep peroneal)
***ankle plantar flexion - S1 S2 (tibial)
***foot inversion - L4 L5 (posterior tibial)
***foot eversion - L5 S1 (superficial peroneal)
* compare between L and R

* GRADE
**0 nil
**1 flicker of movement
**2 movement cannot overcome gravity
**3 movement cannot overcome any resistance
**4 movement is weaker than normal
**5 normal

==Special Tests==
===Pronator Drift===
*have the patient stand with eyes closed and arms held straight out and hands supinated
* + → patient cannot maintain this position
**muscle weakness (pronation and outward drift)
**UMN lesion (pronation and downward drift)

===Fine Finger Movements===
*ask patient to touch each finger to crease of thumb (show patient how) and speed it up
*look for right and left differences, slow if UMN lesion

===Clonus===
*Ankle or Patellaer clonus in UMN Lesion

==Reflexes==
===Dorsal Tendon Reflexes===
*biceps tendon (C5-6)
*brachioradialis tendon (C5-6)
*triceps tendon (C6-8)
*knee jerk (L2-4)
*Achilles tendon (S1-2)

*hyperactive ankle jerk → examine for clonus at knee and ankle
*absent → use reinforcements (teeth clenching for UL, Jendrassik’s maneuver for LL)

*UMN → hyperreflexia, but may be flaccid
*LMN → diminished reflexes

===Grading===
*0 nil
*1 low normal
*2 normal
*3 high normal
*4 clonus (sustained > 3 beats)

* note if reinforcements used (teeth clenching, hand grips)

===Babinski’s reflex (L5-S1)===
* + → dorsiflexion of the big toe with/without fanning of the other toes (UMN lesion)
GROSS MOTOR

==Other OSCE Modules==
{{OSCE2}}
[[Category: Neurology]][[Category:OSCE]]