Neurological Examination of the Limbs - Explanation
University of Leicester・15 minutes read
The text outlines a comprehensive neurological examination protocol for assessing a patient's gait, coordination, muscle tone, reflexes, sensation, and proprioception in the arms and legs, including specific tests and evaluations for each area. The examination involves a detailed assessment of various aspects such as muscle bulk, posture, power, and reflexes, culminating in a thorough evaluation of sensory and motor function in both the upper and lower extremities to provide a comprehensive picture of the patient's neurological status.
Insights
- Observing a patient's gait and limb movements, assessing muscle tone, reflexes, and coordination, along with sensory testing, are crucial components of a comprehensive neurological examination.
- The examination process involves a detailed evaluation of muscle bulk, symmetry, reflexes, and sensation in both the arms and legs, utilizing specific tests like the finger-nose test, joint position sense assessment, and Romberg's test to gather essential diagnostic information.
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Recent questions
How is a patient's gait assessed?
By observing stiffness, arm swing, and foot slapping.
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Summary
00:00
Neurological Examination: Assessing Gait, Coordination, and Sensation
- Observing patient's gait for stiffness, spasticity, posture, arm swing, stooping, and foot slapping.
- Testing coordination by walking five steps heel to toe.
- Conducting Romberg's test with eyes open and closed to check for excessive swaying.
- Instructing patient to strip to underclothes for limb examination.
- Inspecting arms and legs for muscle bulk, symmetry, posture, and involuntary movements.
- Testing arm tone by assessing elbow, wrist, and hand movements for abnormalities.
- Evaluating arm power by comparing strength bilaterally from proximal to distal.
- Assessing coordination in arms through finger-nose test and rapid alternating movements.
- Testing reflexes in arms including biceps, triceps, and finger check.
- Examining sensation in arms through pin prick and light touch validation in dermatomal pattern.
- Testing joint position sense, vibration sense, and coordination in arms.
- Examining legs for muscle bulk, posture, tone, clonus, power, coordination, and reflexes.
- Testing coordination in legs using heel-shin test.
- Assessing reflexes in legs including quadriceps, ankle jerk, and plantar responses.
- Testing sensation in legs through pin prick and light touch validation in dermatomal pattern.
- Examining sensation in legs through cotton wool touch validation in dermatomal pattern.
18:11
Testing Proprioception and Vibration Sense in Neurological Examination
- To test proprioception in the toes, move the big toe up and down while the patient's eyes are closed, asking them to identify the direction; if the patient can sense small movements, further testing is unnecessary, but if not, progress to larger movements at the ankle and knee. Vibration sense can be assessed using a 128 Hertz tuning fork on the sternum and then on the big toes, progressing proximally if needed until sensation is detected; this process concludes the full neurological examination of the arms and legs, with additional examinations recommended for cranial nerves, mental function, and potential spinal cord lesions, including sensory testing on the abdomen and chest, and a rectal examination for anal tone and perianal sensation with pin prick.
