Paraplegia is an impairment in motor orsensory function of the lower extremities
HISTORY OF PRESENT ILLNESS DATE OF ONSET MODE OF ONSET Sudden gradual
 PRECIPITATING FACTORS   SPINAL INJURY   VACCINATION• EVOLUTION OF PARALYSIS
PROGRESS OF PARALYSISA. Increasing in severity and extent-cord   compression.B. Improving-inflammation,acute transverse my...
 Degree And Duration Of Paralysis Motor symptoms HISTORY OF PAST ILLNESS TB,Fever,Syphilis Hypertension,DM,alcoholism...
FAMILY HISTORY Hypertension,DM h/o paraplegia in other members of the family-  indicate hereditary paraplegia,paraplegia...
ENQUIRY OF SENSORY SYMPTOMS1.   Loss of sensation2.   Sense of CONSTRICTION3.   Zone of hyperasthesia4.   Root pain5.   Se...
SPECIAL POINTS IN PHYSICAL               EXAMINATION1.   GENERAL SURVEY    Level of consciousness    Decubitus    Lymph...
SPINE EXAMINATION1.   KYPHOSIS        2. SCOLIOSIS
3.GIBBUS   4.SPINA BIFIDA           5.TENDERNESS
NERVOUS SYSTEM Level of consciousness,alertness,orientation and co-  operation HIGHER FUNCTIONS1. Unconscious or alterat...
Cranial Nerve Examination Olfactory Optic Acuity of vision Field of vision Colour vision Ophthalmoscopy or Fundoscop...
 Facial Palpebral fissure,frowning,eye closure,nasolabial  folds,angle of mouth,blowing,whistling,showing of  teeth,drib...
 Vestibulocochlear Glossopharyngeal and Vagus Spinal accesory Hypoglossal
 CRANIAL NERVES Search for optic atrophy-Friedreich’s ataxia,multiple  sclerosis VII th Nerve palsy –1.GBS             ...
MOTOR FUNCTIONS BULK OF MUSCLE1. Inspection2. Palpation3. Measurement
 Tone of muscle Hypotonia Hypertonia1. Spasticity-pyramidal lesions2. Rigidity-extra-pyramidal lesions
POWER OF MUCLEMuscle       Nerve           Root value   MethodFlexors of   Femoral         L 1,2,3      Patient lies supin...
GRADING OF MUSCLE POWER     MEDICAL RESEARCH COUNCIL SCALE Grade 0-Complete paralysis Grade 1-A flicker of contraction o...
 Co-ordination of lower limbs  -If muscle power grade is 4 or aboveHeel knee testToe-finger test Involuntary movements
SENSORY FUNCTION Superficial –Pain,Touch and Temperature Deep-Joint sense,position sense,pressure sense  ,vibration sens...
REFLEX SUPERFICIAL Abdominal Cremastric Plantar DEEP knee jerk Ankle jerk Clonus
 VISCERAL Bladder Bowel Swallowing TROPHIC CHANGES-Bed sores CEREBELLAR FUNCTION AUTONOMIC FUNCTIONS
 RESPIRATORY SYSTEM GI TRACT AND GENITOURINARY SYSTEM CVS LYMPHORETICULAR SYSTEM
Clinical examination paraplegia
Clinical examination paraplegia
Clinical examination paraplegia
Upcoming SlideShare
Loading in...5
×

Clinical examination paraplegia

5,530

Published on

for more presentations

Published in: Health & Medicine
1 Comment
11 Likes
Statistics
Notes
No Downloads
Views
Total Views
5,530
On Slideshare
0
From Embeds
0
Number of Embeds
15
Actions
Shares
0
Downloads
297
Comments
1
Likes
11
Embeds 0
No embeds

No notes for slide

Clinical examination paraplegia

  1. 1. Paraplegia is an impairment in motor orsensory function of the lower extremities
  2. 2. HISTORY OF PRESENT ILLNESS DATE OF ONSET MODE OF ONSET Sudden gradual
  3. 3.  PRECIPITATING FACTORS SPINAL INJURY VACCINATION• EVOLUTION OF PARALYSIS
  4. 4. PROGRESS OF PARALYSISA. Increasing in severity and extent-cord compression.B. Improving-inflammation,acute transverse myelitis or multiple sclerosis.C. Static but progressing very slowly-Degenerative lesions.D. Waxing and waning-MULTIPLE SCLEROSIS
  5. 5.  Degree And Duration Of Paralysis Motor symptoms HISTORY OF PAST ILLNESS TB,Fever,Syphilis Hypertension,DM,alcoholism Lymphadenopathy,pain in spine SIMILAR EPISODES(Multiple sclerosis)
  6. 6. FAMILY HISTORY Hypertension,DM h/o paraplegia in other members of the family- indicate hereditary paraplegia,paraplegia with hereditary ataxia or lathyrism TB
  7. 7. ENQUIRY OF SENSORY SYMPTOMS1. Loss of sensation2. Sense of CONSTRICTION3. Zone of hyperasthesia4. Root pain5. Sensation of pins and needles in lower extremities
  8. 8. SPECIAL POINTS IN PHYSICAL EXAMINATION1. GENERAL SURVEY Level of consciousness Decubitus Lymph nodes Pulse BP Respiration Temperature Oedema
  9. 9. SPINE EXAMINATION1. KYPHOSIS 2. SCOLIOSIS
  10. 10. 3.GIBBUS 4.SPINA BIFIDA 5.TENDERNESS
  11. 11. NERVOUS SYSTEM Level of consciousness,alertness,orientation and co- operation HIGHER FUNCTIONS1. Unconscious or alteration of consciousness, delirium,photophobia2. Behavioural abnormality with speech defects
  12. 12. Cranial Nerve Examination Olfactory Optic Acuity of vision Field of vision Colour vision Ophthalmoscopy or Fundoscopy Oculomotor ,Trochlear and Abducens Trigeminal
  13. 13.  Facial Palpebral fissure,frowning,eye closure,nasolabial folds,angle of mouth,blowing,whistling,showing of teeth,dribbling of saliva Power of individual facial muscle Upper half of face escaped or not Taste sensation of anterior 2/3 of tongue
  14. 14.  Vestibulocochlear Glossopharyngeal and Vagus Spinal accesory Hypoglossal
  15. 15.  CRANIAL NERVES Search for optic atrophy-Friedreich’s ataxia,multiple sclerosis VII th Nerve palsy –1.GBS 2.Lymphomatous deposits producing unilateral or bilateral VIIth nerve palsy
  16. 16. MOTOR FUNCTIONS BULK OF MUSCLE1. Inspection2. Palpation3. Measurement
  17. 17.  Tone of muscle Hypotonia Hypertonia1. Spasticity-pyramidal lesions2. Rigidity-extra-pyramidal lesions
  18. 18. POWER OF MUCLEMuscle Nerve Root value MethodFlexors of Femoral L 1,2,3 Patient lies supine.Hip is fullythigh flexed and resists attempt to extend itAdductors Obturator L2-L4 Patient tries to bring legsof thigh together against resistanceExtensors Inferior gluteal L5-S1 Patient lies prone and tries toof thigh nerve raise the thigh against resistanceAbductors Superior L4-S2 Patient tries to abduct theof thigh gluteal thigh against resistanceFlexors of Sciatic nerve L4L5 Lies prone and tries to flexknee knee against resistanceExtensors Femoral nerve L3L4 Lies supine ,knees extendedof knee and examiner resists it.
  19. 19. GRADING OF MUSCLE POWER MEDICAL RESEARCH COUNCIL SCALE Grade 0-Complete paralysis Grade 1-A flicker of contraction only(visible or palpable)without any movement of joint. Grade 2-Movt. possible only after elimination of gravity(side to side movt. of a limb). Grade 3-Movt. possible against gravity but not against resistance. Grade 4-Movt. Possible against gravity plus resistance but weaker than normal Grade 5-Normal power.
  20. 20.  Co-ordination of lower limbs -If muscle power grade is 4 or aboveHeel knee testToe-finger test Involuntary movements
  21. 21. SENSORY FUNCTION Superficial –Pain,Touch and Temperature Deep-Joint sense,position sense,pressure sense ,vibration sense Cortical sensation-Point localisation,stereognosis
  22. 22. REFLEX SUPERFICIAL Abdominal Cremastric Plantar DEEP knee jerk Ankle jerk Clonus
  23. 23.  VISCERAL Bladder Bowel Swallowing TROPHIC CHANGES-Bed sores CEREBELLAR FUNCTION AUTONOMIC FUNCTIONS
  24. 24.  RESPIRATORY SYSTEM GI TRACT AND GENITOURINARY SYSTEM CVS LYMPHORETICULAR SYSTEM
  1. ¿Le ha llamado la atención una diapositiva en particular?

    Recortar diapositivas es una manera útil de recopilar información importante para consultarla más tarde.

×