Neurological Exam PDF

Neurological exam FME II Physiotherapy degree Neurological exam Ethiology Changes in nerve conduction when: • • • • • Nerve injury Compression Ischemia Rupture Nerve irritation 2 Neurological exam Ethiology 3 Neurological exam Ethiology 4 Neurological exam Reasons to explore Safety •...

Neurological exam FME II Physiotherapy degree Neurological exam Ethiology Changes in nerve conduction when: • • • • • Nerve injury Compression Ischemia Rupture Nerve irritation 2 Neurological exam Ethiology 3 Neurological exam Ethiology 4 Neurological exam Reasons to explore Safety • Possible "red flag" • Presence of neurological changes • Any acute condition, also with a traumatic origin as a complication of a neck or back pain Suspected NS affection Evaluation and re-evaluation • To have a baseline condition to compare • Decision-making assistance 5 Neurological exam Decision-making Don´t do it if it´s not safe Do it previously if: • If an acute process is suspected • Prior to any intersegmental spinal examination that may affect the nerve roots Other situations: • After functional demonstration, active and resisted movements • Before the neurodynamic exam 6 Neurological exam Goals • • • • • Detect abnormalities in the conduction of the PNS Distinguish sensory or motor impairment Distinguish between root or peripheral nerve involvement Attempt to identify the affected root/nerve Attempt to identify the injured area 7 Neurological exam Indications/Contraindications • Indications: • Upper limbs: symptoms extended beyond the shoulder • Lower limb: symptoms extended beyond the gluts, groin or greater trochanter • Contraindications: • None • Adaptations may be necessary 8 Neurological exam Indications/Contraindications • Indications: • Upper limbs: symptoms extended beyond the shoulder • Lower limb: symptoms extended beyond the gluts, groin or greater trochanter • Contraindications: • None • Adaptations may be necessary 9 Neurological exam UQ & LQ Protocol Tone Reflex es 10 Neurological exam UQ Anatomy reminder 11 Neurological exam UQ Power Based on root level/peripheral nerve/1st motor neuron Test 1 or 2 relevant muscles for each level Muscles innervated by a single root, if possible. Test 0-5 • Isometric in the middle range • Do not try to "break the contraction". • Bilateral. Both at the same time or first the asymptomatic side 12 Neurological exam UQ Power XI XI pars cranealis: Neck rotation C1/C2: Neck flexion/extension C3: Neck lateral flexion C4 C4: Shoulder elevation Bilateral C5: Shouder abduction Root Level C6: Elbow flexion C7: Elbow extension C8: Thumb abduction Unilateral T1: Fingers abduction T1 Bilateral 13 Neurological exam UQ Reflexes Bilaterally Use the same technique and patient procedure Key muscles in upper limbs: • Biceps: C5-C6 • Braquiorradialis: C5-C6 • Triceps: C7-C8 0 No evidence of contraction 1+ Decreased, but still present (hypo-reflexic) 2+ Normal 3+ Super-normal (hyper-reflexic) Clonus: Repetitive shortening of the muscle after a single stimulation 4+ 14 Neurological exam UQ Sensitivity Based on root level/peripheral nerve/first motor neuron Always bilateral Always with the same technique Epicritical touch and superficial pain over the same skin distribution by spinal levels • If the epicritical touch is normal, it is not necessary to examine the surface pain • If it is inconsistent, abnormal or absent, we test for superficial pain 15 Neurological exam UQ Sensitivity. Epicritical Explain: • What we are going to do • What we expect from the patient First asymptomatic side From proximal to distal Two ways: • Circumferential test around the limb • Test "key areas" usually at the end of the dermatome Beware with overlapping's Closed eyes would help to differentiate 16 Neurological exam UQ Sensitivity. Painful sensitivity Just if there are any areas of inconsistent, abnormal or absent sensitivity Explain: • What we are going to do • What we expect from the patient First asymptomatic side From proximal to distal Two ways: • Star technique (INtoOUT or OUTtoIN) • Straight Closed eyes would help to differentiate 17 Neurological exam UQ Sensitivity Key areas (with modifications) • C2 – 1 cm lateral to the occipital protuberance at the base of the skull • C3 - Supraclavicular fossa, midclavicular line • C4 - Over the acromioclavicular joint • C5 – Radial side of the antecubital fossa proximally to the lateral epicondyle of the humerus • C6 - Dorsal surface of the proximal phalanx of the thumb • C7 - Dorsal surface of the proximal phalanx of the middle finger • C8 - Dorsal surface of the proximal phalanx of the little finger • T1 - Ulnar side of the antecubital fossa, just proximally to the medial epicondyle of the humerus • T2 - Apex of the axilla/armpit 18 Neurological exam UQ & LQ Sensitivity map 19 Neurological exam LQ Power (exactly the same than UQ) Based on root level/peripheral nerve/1st motor neuron Test 1 or 2 relevant muscles for each level Muscles innervated by a single root, if possible. Test 0-5 • Isometric in the middle range • Do not try to "break the contraction". • Bilateral. Both at the same time or first the asymptomatic side 20 Neurological exam LQ Power L2 Iliopsoas (L2-L3): Hip flexion Quadriceps(L2-L3-L4): Knee extension Unilateral Tibialis anterior (L4) Big Toe Extensor(L5 ) Toe Extensor(L5-S1) ) Peroneals (L5-S1) Calf (S1-S2): Plantar Flexion S2 Monopodal Flexor digitorum (S2) 21 Neurological exam LQ Reflexes Bilaterally Use the same technique and patient procedure Key muscles in upper limbs: • Quadriceps: L3-L4 • Aquilles: S1-S2 0 No evidence of contraction 1+ Decreased, but still present (hypo-reflexic) 2+ Normal 3+ Super-normal (hyper-reflexic) Clonus: Repetitive shortening of the muscle after a single stimulation 4+ 22 Neurological exam LQ Sensitivity (exactly the same than UQ) Based on root level/peripheral nerve/first motor neuron Always bilateral Always with the same technique Epicritical touch and superficial pain over the same skin distribution by spinal levels • If the epicritical touch is normal, it is not necessary to examine the surface pain • If it is inconsistent, abnormal or absent, we test for superficial pain 23 Neurological exam LQ Sensitivity Key areas (with modifications) • Groin: L1 • Upper thigh, anterior and antero-medial: L2 • Antero-medial knee: L3 • Back of foot: L4 • 1st Toe (medial part): L5 • Lateral side of the foot: S1 • Under the heel: S2 • Perineum: S3-S4 24