Palmer Nms Exam 2 Dr. Vannatta

Front 1

Supraspinatus: segmental innervation? peripheral nerve?

Back 1

C (4)-5-6 Suprascapular C5 is primary

Front 2

Deltoid: segmental innervation? peripheral nerve?

Back 2

C5-6 Axillary C5 is primary

Front 3

Biceps: segmental innervation? peripheral nerve?

Back 3

C5-6 Musculocutaneous C5 is primary

Front 4

Brachioradialis: segmental innervation? peripheral nerve?

Back 4

C5-6 Radial C5 is primary

Front 5

Wrist Extension: segmental innervation? peripheral nerve?

Back 5

C6-7-8 Radial C6 is primary

Front 6

Triceps: segmental innervation? peripheral nerve?

Back 6

C6-7-8-(T1) Radial C7 is primary

Front 7

Wrist Flexion: segmental innervation? peripheral nerve?

Back 7

C6-7-8-(T1) Median, Ulnar C7 is primary

Front 8

Finger Extension: segmental innervation? peripheral nerve?

Back 8

C6-7-8 Radial C7 is primary

Front 9

Finger Flexion: segmental innervation? peripheral nerve?

Back 9

C7-8-T1 Median, Ulnar C8 is primary

Front 10

Finger Abduction: segmental innervation? peripheral nerve?

Back 10

C8-T1 Ulnar T1 is primary

Front 11

Finger Adduction: segmental innervation? peripheral nerve?

Back 11

C8-T1 Ulnar T1 is primary

Front 12

Muscle grading-- Complete range of motion against gravity with full resistance

Back 12

5/5 Normal

Front 13

Muscle grading--Complete range of motion against gravity with some resistance

Back 13

4/5 Good

Front 14

Muscle grading -- Complete range of motion against gravity - enough strength to put joint through normal range of motion

Back 14

3/5 Fair

Front 15

Muscle grading-- Complete range of motion with gravity eliminated. This can be done by turning the patient on a side so they do not have to overcome the pull of gravity.

Back 15

2/5 Poor

Front 16

Muscle grading -- No evidence of slight contraction but no joint motion. The doctor can feel the muscle contract but there is no joint motion.

Back 16

1/5 Trace

Front 17

Muscle grading -- No evidence of contraction

Back 17

0/5 No evidence of contraction

Front 18

An increased muscular resistance felt by the examiner during quick joint movement, which then quickly fades away ("clasped knife"). In most clinical circumstances have associated cortical or pyramidal pathway lesions (Upper Motor neuron lesion).

Back 18

Spasticity

Front 19

Tension at first, followed by a decrease in that tension as the joint opens.

Back 19

Clasped knife

Front 20

An involuntary muscular resistance felt when moving a resting joint and persists as the joint is moved through its entire range of motion. The mechanism for this may be related to muscle spindle mechanism interference from diseased extrapyramidal structures (UMNL)

Back 20

Rigidity

Front 21

Usually indicative of neurological damage at the level of the reflex arc (LMNL), cerebellar disease may cause diffuse form

Back 21

Hypotonia (decreased muscle tone)

Front 22

A phenomenon that is in no way related to vascular shock, May occur following acute, severe upper motor neuron damage, in either the brain (cerebral shock) or the spinal cord (spinal shock). The unique finding is that a suddenly occurring and severe UMNL, which would typically cause central nervous system findings, first cause only peripheral type neurological findings.

Back 22

Neural Shock

Front 23

Loss of normal neurological function: reductions in muscle tone, muscle stretch reflexes, muscle strength and muscle volume. LMNL produce only this.

Back 23

Deficit phenomena

Front 24

Exaggerations or perversions of normal neurological function and are due to a loss of cortical inhibition. Hyper-reflexia, hypertonia and pathological reflexes would be this.

Back 24

Release phenomena (named due to the release from descending cortical inhibition.)

Front 25

Muscle stretch reflexes: Biceps--Segmental innervation? Peripheral nerve?

Back 25

C5-6 C5 is primary Musculocutaneous

Front 26

Muscle stretch reflexes: Brachioradialis--Segmental innervation? Peripheral nerve?

Back 26

C5-6 C6 is primary Radial

Front 27

Muscle stretch reflexes: Triceps--Segmental innervation? Peripheral nerve?

Back 27

C6-7-8-(T1) C7 is primary Radial

Front 28

Muscle stretch reflexes: Finger flexion--Segmental innervation? Peripheral nerve?

Back 28

C7-8-T1 C8 is primary Median, Ulnar

Front 29

Reflex Grading System (Wexler Scale) -- Identify what 0, +1, +2, +3, +4 are

Back 29

0=Absent with reinforcement
+1 = Hypoactive with reinforcement
+2 = Normal
+3 = Hyperactive
+4 = Hyperactive with transient (or sustained) clonus

Front 30

Describe exam procedure to assess deep tendon reflexes

Back 30

Position the patient correctly to assure they are relaxed and have their eyes closed and looking away. Strike the reflex tendon, if nothing reposition and try again. If nothing still, try Jendrassik maneuver (distraction). Look for speed of reaction grade, vigor of response and length of contraction.

Front 31

Describe how to perform Reinforcement (Jendrassik maneuver)

Back 31

On performing the patellar reflex (for example) the patient is asked to hook his fingers and try to pull them apart at the time the reflex is being tested. Reinforcement can be done a number of ways by distracting the patient while performing the reflex. If using reinforcement, add an R to the grade (ie +1R)

Front 32

A continued involuntary rapid flexion and extension of a muscle while a joint is under sustained resistance. It is due to a rapid-fire elicitation of the stretch muscle reflexes. May be present at the wrist (extension) knee and ankle.

Back 32

Pathological clonus

Front 33

Hoffman sign - sharp forcible flick of the doctor's thumb against the patient's middle finger. What is positive and what does it indicate?

Back 33

Flexion of fingers and adduction of the thumb - UMNL lesion above C5 in Corticospinal tract

Front 34

Tromner sign --Tap the volmar surface of the middle finger. What is positive and what does it indicate?

Back 34

Flexion of fingers and adduction of the thumb - UMNL lesion above C5 in Corticospinal tract

Front 35

Rossolimo sign of the foot --Tap the ball of the foot or tap the tips of the toes. What is positive and what does it indicate?

Back 35

Plantar flexion of the toes - UMNL Lesion above C5 in the Corticospinal tract

Front 36

Babinski Sign - Stroke plantar foot from the heel to metatarsals to big toe. What is positive and what does it indicate?

Back 36

Normal = Plantar flexion of toes and foot Abnormal = dorsiflexion of great toe and flaring of the other toes. UMNL Corticospinal tract

Front 37

Chaddock sign - Stroke lateral malleolus from heel to toe. What is positive and what does it indicate?

Back 37

Normal = No motion of toes and foot Abnormal = dorsiflexion of great toe and flaring of other toes UMNL Corticospinal tract

Front 38

Oppenheim sign - Stroke anterior tibial surface from superior to inferior. What is positive and what does it indicate?

Back 38

Normal = no motion of the toes and foot Abnormal = dorsiflexion of great toe and flaring of other toes UMNL Corticospinal tract

Front 39

Gordon sign - Squeeze the calf. What is positive and what does it indicate?

Back 39

Normal = no motion of toes and foot Abnormal = dorsiflexion of great toe and flaring of the other toes UMNL Corticospinal tract

Front 40

Schaefer Sign - Squeeze the Achilles. What is positive and what does it indicate?

Back 40

Normal = no motion of toes and foot Abnormal = dorsiflexion of great toe and flaring of the other toes UMNL Corticospinal tract

Front 41

Shaking in the fingers due to agonists and antagonists actions

Back 41

Physiological tremor

Front 42

Movement the patient cannot start or stop at the doctor's command. Characteristic of a given dyskinesia, may be caused by a structural or biochemical nervous system lesion.

Back 42

Involuntary movement

Front 43

Startle reactions and are usually normal occurrences. May involve the whole body or just a large muscle group. Seen in: acute chronic encephalitis, meningitis, toxic metabolic states, degenerative disorders, vascular and neoplastic conditions and may be seen with lesions of the peripheral nerves, nerve roots and spinal cord.

Back 43

Myoclonic jerks

Front 44

Twitches within the muscle, often after exercise and are not pathological.

Back 44

Benign Fasciculations

Front 45

Rapid tremor of low amplitude that worsens with volitional movement.

Back 45

Emotional tremor

Front 46

Hereditary tremor that usually affects the hands

Back 46

Familiar tremor

Front 47

Similar tremor to familiar, associated with aging

Back 47

Senile tremor

Front 48

"pill-rolling" at rest and disappears or damps with volitional movement (basal ganglion lesion)

Back 48

Parkinsonian tremor

Front 49

tremor that worsens with refined volitional movement (cerebellar pathology)

Back 49

Intention tremor

Front 50

tremor that occurs during maintenance of an intentional posture, disappears with movement.

Back 50

Postural tremor

Front 51

Random, quick movements simulating fragments of normal movements

Back 51

Nontremorous Hyperkinesia or Chorea

Front 52

Slow, writing movements of the fingers and extremities that may come and go and are usually associated with pyramidal tract signs

Back 52

Athetosis

Front 53

Slow, alternating contraction and relaxation of agonists and antagonists, with one movement predominating for a long time; causes fixed joint contractures.

Back 53

Dystonia

Front 54

Awkwardness of movement as opposed to weakness is a characteristic of both ________ and ______ ________ lesion.

Back 54

Cerebellar, basal ganglion

Front 55

Intention tremor, ataxia

Back 55

cerebellum lesion

Front 56

Awkward in involuntary movements: resting tremor, chorea, athetosis, hemiballismus

Back 56

basal ganglion lesion

Front 57

A violent, flinging movement of half of the body (indicates basal ganglion lesion)

Back 57

Hemiballismus

Front 58

Quick, repetitive movements of the face, tongue or extremities

Back 58

Tics

Front 59

Motor unrest manifested as continual shifting of posture and/or movement (parkinson's and psychotropic medication use)

Back 59

Akathisia

Front 60

Tonic or clonic spasms of all or part of the body

Back 60

Epilepsy

Front 61

Involuntary movements of the face, mouth, tongue and limbs. Onset usually months after prolonged use of neuroleptic agents. (neuroleptic agents are drugs given for psychotic disorders). The largest single category of involuntary movement.

Back 61

Tardive dyskinesias

Front 62

Characteristic of posterior column disease and results from loss of proprioception in extremities. Patients walk with a wide base, slapping feet and usually watching their feet so they know where they are.

Back 62

Tabetic or Ataxic gait -- in the dark or with their eyes closed, the ataxia is much worse.

Front 63

Affected leg is rigid and swung from the hip in a semicircle; the patient leans to the affected side and the arm on that side is held in a rigid, semiflexed position.

Back 63

Hemiplegic gait (brain lesion UMNL resulting in paralysis of the opposite side of the body)

Front 64

Characteristic of spastic paraplegia. The legs are adducted, crossing alternately in front of one another with the knees scraping together. The resulting steps are short and progression slow.

Back 64

Scissors gait

Front 65

As seen in acute alcoholism may result from drug poisoning, multiple neuritis, brain tumors, multiple sclerosis or general paresis.

Back 65

Drunken or staggering gait

Front 66

Results from dislocated hips or muscular dystrophies with weakness of the hips. In either case, the trunk muscles are drawn into play, so that the patient rolls from side to side.

Back 66

Waddling or clumsy gait

Front 67

Characterized by high knee action and flopping of the feet (or foot). Even when the leg is raised the toes tend to drag along the floor. Occurs with paralysis of the anterior tibial group of muscles, as in alcoholic neuritis, peroneal nerve injury, poliomyelitis and progressive muscular atrophy.

Back 67

Steppage Gait (foot drop)

Front 68

Characterized by marked irregularity and unsteadiness associated with vertigo and a tendency to reel to one side. Lower extremities appear loose; movement of the advancing limb starts slowly, but the limb is unexpectedly and vigorously flung forward and lands with a stamp on the floor. Gait is wide-based, irregular, reeling or deviated with staggering on turning.

Back 68

Cerebellar gait or ataxia (not looking down as in Tabetic or ataxic gait)

Front 69

Characterized by a forward-leaning posture and short, shuffling steps, beginning slowly at first and becoming more rapid ("marche a petits pas"). Patients with the classic features of parkinsonism have a stooped posture, take short steps, and frequently accelerate rapidly, so that they appear to be chasing their center of gravity.

Back 69

Propulsion or Festination gait

Front 70

Simulate various paralyses (e.g. monoplegias, hemiplegias, or paraplegias)but differ from the organic forms in being more pronounced and complete, with the ability to use the limb in emergencies. The gait is apt to be bizarre or fantastic, characterized by exaggerated balancing motions and inconsistency between the gait shown and the patient's actual ability to move the limb voluntarily.

Back 70

Hysterical gait (non-organic, psychological)

Front 71

a form of hysterical ataxia with such bizarre incoordination that the patient is unable to stand or walk, yet all leg movements can be performed normally while the patient is sitting or is in bed.

Back 71

Astasia-Abasia

Front 72

When pain is produced by weight-bearing on a lower extremity, the patient puts the affected limb down carefully and takes a short step to get the weight off the painful limb as soon as possible. The good limb is brought forward rapidly and lands vigorously on the floor.

Back 72

Limping Gait

Front 73

The stretching of a few muscle/tendon fibers with less than 10% tearing of the fibers, and without a palpable defect.

Back 73

Grade 1 Strain

Front 74

About a 10-50% tear of the fibers and a palpable defect is usually present.

Back 74

Grade 2 Strain

Front 75

Involves extensive tearing or a complete rupture of the muscle/tendon fibers with a large palpable depression in the muscle unit

Back 75

Grade 3 Strain

Front 76

Ranges from a stretch without a tear to about 20% tear of a ligament

Back 76

Grade I Sprain

Front 77

Involves about 20-75% percent ligamentous tear

Back 77

Grade II Sprain

Front 78

Represents a 75% tear to a complete disruption of the ligament capsule.

Back 78

Grade III Sprain

Front 79

List some reasons why you would take an Xray

Back 79

Soft tissue injury, bony malalignment, dislocations, fractures, degenerative orthopathic disease, abnormalities in the growth plate

Front 80

List some reasons why you would take a CT scan

Back 80

IVD protrusions or herniations, facet disease, centrl canal and lateral recess stenosis, metabolic bone disease (Osteoporosis, tumor and soft tissue masses)

Front 81

List some reasons why you would take an MRI

Back 81

Reveal early stages of DDD, spinal cord tumors, metastatic bone disease, cerebral edema, meniscal tear, soft tissue tumor

Front 82

When is MRI with contrast indicated?

Back 82

If the patient has had a previous surgery in disc protrusion or herniation, contrast gadolinium must be used to determine if complaints are from old scar tissue or new herniated nucleus pulposus)