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# Inspection ## Abnormal Involuntary Movements 1. Describe: see details later in Parkinsonism case. - Pattern: - Static or kinetic - Slow or rapid - Regular or irregular - Fine or flappy (coarse) tremors - Factors that increase & decrease the movement 2. Dis...

# Inspection ## Abnormal Involuntary Movements 1. Describe: see details later in Parkinsonism case. - Pattern: - Static or kinetic - Slow or rapid - Regular or irregular - Fine or flappy (coarse) tremors - Factors that increase & decrease the movement 2. Distribution: - UL or LL or both, head & neck, Unilateral or bilateral, Distal or proximal ## Posture of the Patient: - Hemiplegia: flexion of UL & Extension of LL - Paraplegia in flexion: flexion of both LL - Paraplegia in extension: extension of both LL - Parkinsonism: generalized flexion attitude (Gorilla like) - LMNL (Peripheral neuropathy): foot or wrist drop ## Circumference of the muscle = state of the muscle: 1. Normal 2. Wasting: flatness or hollowness of muscles: - What are the causes of muscle wasting? See discussion later. - Unilateral: - Bilateral: - Wasting landmarks: - Upper limbs: - Start distally at interossei, thenar, hypothenar leading to prominent metacarpal bones & tendons - Proximal: flat shoulder - Lower limbs: - Start distally at intrinsic foot muscle and interossiei leads to pes cavus and prominent metatarsal bones & tendons - Proximal: lateral aspect of the leg & medial aspect of thigh (vastus medialis) 3. Hypertrophied: - True hypertrophy: increase the power - False or Pseudohypertrophy: decrease the power - What are the causes of Pseudohypertrophy? See discussion later. ## Dysplastic (Trophic) changes: - Fall of hair, brittle nails, trophic ulcers, thin skin, loss of SC fat & Charcot's joint - What are the diseases with marked tropic changes? See discussion later. ## Deformity in the skeletal system: - Abnormal position (claw hand, dropped foot) - Pes cavus (high arched foot) - Pes plannus (flat foot) - Hallux valgus or varum - Hammer toes & Talipes equinovarus - What are the causes of pes cavus? See discussion later.