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Questions and Answers
Which of the following terms describes a tremor that occurs when a person is not moving?
Which of the following terms describes a tremor that occurs when a person is not moving?
What posture is typically observed in a patient with Parkinsonism?
What posture is typically observed in a patient with Parkinsonism?
Which of the following describes the wasting of muscles from the distal interossei in the upper limbs?
Which of the following describes the wasting of muscles from the distal interossei in the upper limbs?
Which skeletal deformity is characterized by a high arched foot?
Which skeletal deformity is characterized by a high arched foot?
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What is the term for muscle enlargement that doesn't result in increased muscle power?
What is the term for muscle enlargement that doesn't result in increased muscle power?
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Which abnormal involuntary movement pattern is described as regular?
Which abnormal involuntary movement pattern is described as regular?
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What is a characteristic muscle change in LMNL (Peripheral neuropathy)?
What is a characteristic muscle change in LMNL (Peripheral neuropathy)?
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Which position is observed in hemiplegia?
Which position is observed in hemiplegia?
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What does the presence of a flat shoulder indicate?
What does the presence of a flat shoulder indicate?
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Which of the following is a dystrophic change?
Which of the following is a dystrophic change?
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What is a distinguishing feature of pathological fasciculations?
What is a distinguishing feature of pathological fasciculations?
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Which type of myotonia is examined by percussion of the thenar eminence resulting in thumb adduction?
Which type of myotonia is examined by percussion of the thenar eminence resulting in thumb adduction?
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Which of the following is NOT a known cause of physiological fasciculations?
Which of the following is NOT a known cause of physiological fasciculations?
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Which description best defines electrical myotonia?
Which description best defines electrical myotonia?
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What is the typical EMG finding in physiological fasciculations?
What is the typical EMG finding in physiological fasciculations?
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What phenomenon occurs when a patient is asked to clench their fist and unable to open it immediately?
What phenomenon occurs when a patient is asked to clench their fist and unable to open it immediately?
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Study Notes
Abnormal Involuntary Movements
- Abnormal movements can be classified into different patterns, including:
- Static or kinetic movements
- Slow or rapid movements
- Regular or irregular movements
- Fine or flappy (coarse) tremors
- Factors can increase or decrease the movement, and it is essential to identify these factors
Distribution of Abnormal Movements
- Abnormal movements can affect:
- Upper limb (UL) or lower limb (LL) or both
- Head and neck
- Unilateral or bilateral
- Distal or proximal
Posture of the Patient
- Hemiplegia: characterized by flexion of the upper limb and extension of the lower limb
- Paraplegia in flexion: characterized by flexion of both lower limbs
- Paraplegia in extension: characterized by extension of both lower limbs
- Parkinsonism: characterized by a generalized flexion attitude (Gorilla-like posture)
- LMNL (Peripheral neuropathy): characterized by foot or wrist drop
Circumference of the Muscle
- Normal muscle circumference
- Wasting:
- Caused by various factors (to be discussed later)
- Can be unilateral or bilateral
- Wasting landmarks:
- Upper limbs: start distally at interossei, thenar, hypothenar leading to prominent metacarpal bones and tendons, and proximally at the flat shoulder
- Lower limbs: start distally at intrinsic foot muscle and interossiei leading to pes cavus and prominent metatarsal bones and tendons, and proximally at the lateral aspect of the leg and medial aspect of thigh (vastus medialis)
- Hypertrophied:
- True hypertrophy: increases power
- False or Pseudohypertrophy: decreases power
- Caused by various factors (to be discussed later)
Dysplastic (Trophic) Changes
- Characterized by:
- Fall of hair
- Brittle nails
- Trophic ulcers
- Thin skin
- Loss of subcutaneous fat
- Charcot's joint
- Can occur in diseases with marked tropic changes (to be discussed later)
Deformity in the Skeletal System
- Abnormal positions, such as:
- Claw hand
- Dropped foot
- Pes cavus (high arched foot)
- Pes plannus (flat foot)
- Hallux valgus or varum
- Hammer toes
- Talipes equinovarus
- Caused by various factors (to be discussed later)
Fasciculations
- Definition: Fasciculation refers to the spontaneous contraction of a group of muscles, which is visible and palpable.
- Comparison to Fibrillation: Fibrillation is the spontaneous contraction of a single muscle fiber, which is hardly visible except in the tongue.
-
Types of Fasciculations:
- Physiological Fasciculation: caused by anxiety, fatigue, coffee, or smoking, resulting from irritation of AHCS.
- Pathological Fasciculation:
- Coarse type: associated with muscle wasting, and EMG shows giant potentials.
- Fine type: not associated with muscle wasting, and EMG is normal.
- Percussion Technique: To avoid physiological fasciculations, all limbs should be percussed by finger flicking or light percussion with a hammer.
Myotonia
- Definition: Myotonia refers to the delayed relaxation of skeletal muscle after muscle contraction (myotonic phenomena).
-
Examination Techniques:
-
Mechanical Myotonia: Percussion by hammer on:
- Thenar eminence: adduction of thumb with delayed abduction.
- Tongue: dimple formation.
-
Voluntary Myotonia: Ask the patient to:
- Catch something or shake their hand.
- Clench their fist, and observe the delayed opening of the hand.
- Electrical Myotonia: 2-3 milliamperes are enough to produce muscle contraction, indicating hyperexcitability (normally 6 milliamperes are needed).
-
Mechanical Myotonia: Percussion by hammer on:
-
Types of Myotonia:
- Myotonia congenita (hypertrophica).
- Myotonia atrophica.
- Myotonia acquisita.
- Myotonia paradoxica.
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Description
This quiz covers abnormal involuntary movements, including patterns, factors that affect them, and their distribution in the body. It also touches on postures of patients with certain neurological conditions.
