The document describes the examination of the motor system, including inspection of muscle state, tone, power, and reflexes. Inspection assesses muscle size, fasciculations, movements, and deformities. Tone is tested through passive movements and shaking/lifting techniques to identify hypotonia or hypertonia. Muscle power is graded from 0-5 based on strength against resistance. Specific muscles are then tested individually at each major joint.
4. 1) Inspection
Muscle state
Fasciculation
Abnormal movement
Skeletal deformities
Trophic changes
Examination:
Examiner stand central
Compare between both sides
Compare between distal & Proximal
Measurement:
use measurement tape to measure muscle
Determine the most bulky part of the muscle
Measure its distance from a fixed bony prominence
Measure the circumference using a measurement tape
In the other side, measure the circumference at the same
distance from the bony prominence.
14. 1) Inspection
Muscle state
Fasciculation
Abnormal movement
Skeletal deformities
Trophic changes
Fasciculation:
Spontaneous contraction of a group of muscles fibers
It is visible for the doctor & perceived by the patient
Causes:
Physiological: with fatigue, anxiety, caffeine
Pathological: “irritation of AHC”
Motor neurone disease
Cervical spondylosis
Poliomyelitis
15. 1) Inspection
Muscle state
Fasciculation
Abnormal movement
Skeletal deformities
Trophic changes
Fasciculation:
How to elicit:
Tapping the muscle
Where to look for:
Deltoid
Pectoralis major
Quadriceps
16. 1) Inspection
Muscle state
Fasciculation
Abnormal movement
Skeletal deformities
Trophic changes
Fasciculation:
17. 1) Inspection
Muscle state
Fasciculation
Abnormal movement
Skeletal deformities
Trophic changes
Fibrillation:
Spontaneous contraction of a single muscle fiber
Seen only in the tongue
Indicate AHC irritation
19. 1) Inspection
Muscle state
Fasciculation
Abnormal movement
Skeletal deformities
Trophic changes
Pes Cavus: exaggerated arch of the foot
Congenital: short big toe & hammer toe
Acquired: big toe larger than adjacent one
20. 1) Inspection
Muscle state
Fasciculation
Abnormal movement
Skeletal deformities
Trophic changes
Pes Cavus: exaggerated arch of the foot
Congenital: short big toe & hammer toe
Acquired: big toe larger than adjacent one
Value: point to hereditary disorders
Scoliosis
Kyphosis
Lordosis
21. 1) Inspection
Muscle state
Fasciculation
Abnormal movement
Skeletal deformities
Trophic changes
Due to loss of trophic impulses from AHC and loss of
muscle tone.
Trophic ulcers
Coldness
Dry skin
Loss of hair
22. 2) Muscle Tone
Mechanism
Hypotonia
Hypertonia
Examination
Muscle tone: resistance to passive movements
24. 2) Muscle Tone
Mechanism
Hypotonia
Hypertonia
Examination
Causes:
Pyramidal Lesion: “Spasticity”
Affect antigravity muscles (flexors of upper limbs, extensors of
lower limb)
Clasp Knife (initial resistance suddenly released)
Extrapyramidal Lesion: “Rigidity”
Affect flexors more than extensors
Lead pipe: continuous resistance through the movement
Cog wheal: a combination of lead pipe rigidity and tremor which
presents as a jerky resistance to passive movement
25. 2) Muscle Tone
Mechanism
Hypotonia
Hypertonia
Examination
1- Passive flexion & extension:
Patient must be calm, relaxed
Grasp patient from bony prominence, don’t grasp the muscle.
Use all range of movements
Compare both sides
26. 2) Muscle Tone
Mechanism
Hypotonia
Hypertonia
Examination
2- Shaking method:
Used for distal joints (wrist & ankle)
Catch the upper limb from the styloid process of radius and ulna
Shake wrist from side to side and from front backwards
3- Gower method:
Used only for shoulder joint
Stand behind the patient, put your hands in the axilla and try to
hold the patient.
Slipping of the arms indicate hypotonia
27. 2) Muscle Tone
Mechanism
Hypotonia
Hypertonia
Examination
N.B:
Paratonia “gegenhalten”:
Resistance of the patient to passive movement.
Occur in cortical brain disorders as dementia
How to differentiate from spasticity:
No pyramidal signs, no clasp knife
How to differentiate from Rigidity:
The faster the movement the more the resistance
28. 3) Muscle Power
MRC Grades
Types of Weakness
Examination
Grade 5: Muscle contracts normally against full resistance.
Grade 4: Muscle strength is reduced but muscle
contraction can still move against resistance.
Grade 3: Muscle strength is further reduced such that the
joint can be moved only against gravity with the examiner's
resistance completely removed.
Grade 2: Muscle can move only if the resistance of gravity
is removed. As an example, the elbow can be fully flexed
only if the arm is maintained in a horizontal plane.
Grade 1: Only a trace or flicker of movement
Grade 0: No movement is observed.
29. 3) Muscle Power
MRC Grades
Types of Weakness
Examination
UMNL:
Weakness affect progravity muscles more than antigravity
muscles, extensors of the upper limb and flexors of the
lower limbs.
LMNL:
Varies according to the disorder:
Peripheral neuropathy: Distal, bilateral, symmetrical
Myopathy: Proximal, bilateral symetrical
Myasthenia: Descending weakness
GBS: Ascending weakness
30. 3) Muscle Power
MRC Grades
Types of Weakness
Examination
Fix the proximal joint
Grasp the patient from bony prominence to avoid
interfering with muscle contraction
Ask patient to move his joint against your resistance
Compare both sides