This document summarizes the components of a motor system examination, including muscle state, tone, power, and coordination. It describes how to evaluate each component, such as inspecting for muscle wasting or fasciculations, testing tone using maneuvers like Gower's sign, grading strength using the MRC scale, and assessing coordination through finger-nose and heel-knee tests. It also differentiates between types of abnormal tone like spasticity and rigidity. The overall motor exam is divided into inspection of muscle and skeletal features, assessment of tone, strength, and coordination through specific physical exam techniques.

1. Neurology
Motor system Examination
Dr mohamed rizk khodair
lecturer of neurology
October 6 university
Mohamedrizk.med@edu.edu.eg
‫والجراحة‬ ‫الطب‬ ‫كلية‬

2. The motor system evaluation is divided
into the following:
A. Muscle state
B. Muscle tone
C. Muscle power
D. Coordination system
E. D) Gait

3. A) Muscle state examination
Inspection :
Body positioning
Muscle waste ( wasting or hypertrophy )
Measuring of the limbs ( if there is any suspicion about mild difference)
Involuntary movements, fasciculation .
Skeletal deformities
Trophic changes
Palpation :
For tenderness
Percussion :
For myotonia

4. Body positioning :

5. Muscle wasting
Distribution :
Focal or generalized (proximal or distal)
Unilateral or bilateral
Symmetrical or not

6. Muscle wasting
pseudo hypertrophy

7. Skeletal deformities
Look for skeletal deformities : pes cavus , scoliosis

8. Muscle inspections
Fasciculation : examine the bulky muscle
Trophic changes

9. Muscle inspections
abnormal movements
• Distribution
• Rest , postural or action
• Frequency
• Amplitude
• Rhythmic or not
• What increase or decrease them

10. B) Muscle tone examination
A: upper limbs :
Shoulder : Gower’s method
Elbow : passive flexion and extension
Wrist : shaking , passive flexion and extension
B: lower limbs :
Hip : rolling
Knee : hooking , passive flexion and extension
Ankle : shaking , passive flexion and extension

11. Abnormal muscle tone
• Hypotonia
??? causes of hypotonia
• Hypertonia : Spasticity , rigidity (cogwheel & lead pipe )
??? differentiation between spasticity & rigidity

12. Spasticity Rigidity
Due to pyramidal tract lesion (UMNL) Due to extra-pyramidal lesion
Velocity -dependent hypertonia.
Initial (or near the middle) resistance then releases (clasp
entire movement)
lead pipe or
knife phenomenon). Cogwheels (interrupted
by tremor).
Specific distribution of hypertonia
Specific distribution of hypertonia; affecting:
-Flexors (i.e., more resistance to extension) pronator &
adductors of upper limb.
- Extensors (i.e., more resistance to flexion); adductors &
ankle plantar flexors of Lower limb.
(unidirectional).
Equal increase in tone in the flexors
and extensors (bidirectional)
Easier to feel with rapid movements or quick jerk (spastic
catch)
Easier to feel with slower
movements
In hemiplegic, quadriplegic, monoplegia, paraplegic
distribution.
Usually affects limbs and trunk, symmetrical
or asymmetrical, ±
hemi-distribution
Associated with other UMN signs (weakness, increase
DTRs, clonus, extensor plantar response, circumduction
or scissoring gait).
Associated with other extrapyramidal signs
such as bradykinesia, tremor, shuffling gait ).

13. C) Muscle power Examination
• Power or strength is tested comparing the patient’s strength against your
own
• Compare one side to the other
• Grade strength using the medical research council scale

14. Upper limb
1. Shoulder ( adduction , abduction , flexion, extension, individual muscle testing )
2. Elbow ( flexion and extension )
3. Wrist ( flexion and extension )
4. Hand ( thumb, interossesi, lumbricals )

15. Lower limb
1. Hip : flexion , extension, abduction, adduction
2. Knee : flexion , extension
3. Ankle : dorsiflexion , plantarflexion ,inversion , eversion
Don’t forget the trunk muscle ( abdominal and back muscle )

16. D) Coordination System
examination
A. Upper limb (With opened and closed eyes)
1. Finger to nose ,
2. Finger to finger test ,
3. Finger to nose to doctor’s finger test
4. Dysdiadokokinesia : inability to perform rapid alternating movement (pronation and supination
)
5. Rebound phenomenon : with sudden release of flexed elbow
6. Buttoning or unbuttoning test : earliest sign

17. Finger to nose to doctor’s finger test
Finger to nose test Finger to finger test
Dysdiadokokinesia
Rebound phenomenon

18. B. Lower limb : (With opened and closed eye )
1.Heel to knee test.
2. Standing : swaying ----- truncal ataxia
3. Walking along straight line
4. Romberg sign

19. E) Gait abnormality

20. Thank you
Mohamedrizk.med@edu.edu.eg