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neurological examination

Indications: - assessment of neurologic disease - motor function is low risk, high value means of assessing movement disorders [3] Procedure: Alertness, orientation CN II-XII - pupils, extra-ocular muscles, tongue (CN 12), gag, hearing (Weber & Rinne test) DTR: - biceps: flexion at elbow (C5, C6) - triceps: extension at elbow (C6, C7) - brachioradialis: flexion & supination of forearm (C5, C6) - patellar: extension at knee (L2, L3, L4) - ankle: plantar flexion at ankle (S1) - Plantar flexion (Babinski) - check for clonus - check for tremor motor: - flexion at the elbow (C5, C6, biceps), - extension at the elbow (C6, C7, C8, triceps) - abduction at the shoulders (deltoids) - shrugging of shoulders, turning of head (CN XI) - extension at wrist (C6, C7, C8, radial nerve) - handgrip (C7, C8, T1), - finger abduction (C8, T1 & ulnar nerve) - opposition of thumb (C8, T1 & median nerve) gait (if possible) - rise from a sitting position without arm support - heel to toe or tandem walk - walk on toes: tests plantar flexion - walk on heels: tests dorsiflexion if gait not testable: - flexion at the hip (L2, L3, L4, iliopsoas) - adduction at the hips (L2, L3, L4, adductors) - abduction at the hips (L4, L5, S1, gluteus medius & minimus) - extension at the hips (S1, gluteus maximus) - extension at the knee (L2, L3, L4, quadriceps) - flexion at the knee (L4, L5, S1, S2, hamstrings) - dorsiflexion at the ankle (L4, L5) - plantar flexion at the ankle (S1) finger to nose: tests for dysmetria (cerebellar) heel to shin, repeat with eyes closed to check position sense rapid alterating movements: tests for dysdiadochokinesis (cerebellar) sensory: - position sense - vibratory sensation - Romberg - pronator drift - stereognosis - 2 point discrimination: 5 mm on finger pads

Related

nerve root

General

physical examination

References

  1. Scherokman B, Selwa L and Alguire PC Approach to Common Neurological Symptoms in Internal Medicine American Academy of Neurology http://www.aan.com/go/education/curricula/internal/toc
  2. NeuroLogic exam University of Utah http://library.med.utah.edu/neurologicexam/html/coordination_normal.html
  3. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015