NMS I - Exam 2 Part 1: Involuntary Movement & Gaits and Thoracic Outlet Syndrome (TOS)

What is movement that the patient cannot start or stop at the doctors command, and may be from a structural or biochemical nervous system lesion?

Involuntary Movement (Dyskinesia)

What method do you use to learn history of dyskinesia?

OPQRST method

What type of non-pathological involuntary movement is the shaking in the fingers, hands, or heads?

Physiological Tremor

What type of non-pathological involuntary movement is normal, but some may think it may be seizure disorder?

Myoclonic Jerks

What type of non-pathological involuntary movement is muscle twitching?

Benign Fasciculations

What pathological involuntary movement is a decrease in movement, often seen in depression & parkinsonism?

Hypokinesia

What pathological involuntary movement is an increase in movement that increases with stress and decreases with repose?

Hyperkinesia

What type of involuntary movement tremors are rapid, low amplitude, and worsen with volitional movement?

Emotional Tremors

What type of involuntary movement tremors are hereditary in the hands/head?

Familiar Tremors

What type of involuntary movement tremors are similar to familiar but are due to aging?

Senile Tremors

What type of involuntary movement tremors are "pill-rolling", disappearing on movement? What is this due to?

Parkinsonian

-- Basal ganglion lesion

What type of involuntary movement tremors worsen with refined movement? What is this due to?

Intention Tremor

-- Cerebellar pathology

What type of involuntary movement tremors occur during fixed posture and disappear with movement?

Postural Tremors

What type of involuntary movement is random, quick movement that are fragments of normal movement?

Nontremorous Hyperkinesia or Chorea

What type of involuntary movement is slow writhing movement that may come and go?

Athetosis

What type of involuntary movement is slow, alternating contracitons and relaxations of agonists and antagonists, one movement lasting longer, causing fixed joint contractures?

Dystonia

What type of involuntary movement are violent flinging movements of half of the body?

Hemiballismus

What type of involuntary movement is quick, repetitive movement of the face, tongue, or extremities, associated with emotional stress?

Tics

What type of involuntary movement is continual shifting of posture and or movement (parkinson's and psychotropic medication use)?

Akathisia

What type of involuntary movement is tonic or clonic spasms of all or part of the body?

Epilepsy

What type of involuntary movement is of the face, mouth, tongue, and limbs, with prolonged use of neuroleptic agents for psychotic disorders being a possible cause?

Tardive dyskinesias

What type of gait is a wide base, slapping their feet, watching their feet, with it being worse in the dark and may demonstrate some swaying to one side? What is the cause of this?

Tabetic or Ataxic Gait

-- Posterior Column Disease

What type of gait is when the arm is held in rigid, semiflexed position with the leg swung from the hip in a semicircle by movement of the trunk?

Hemiplegic gait

What type of gait is characteristics of spastic paraplegia, with knees scraping together, steps are slow and short, with both limbs involved?

Scissors Gait

What type of gait has the MC cause of acute alcoholism, but can be due to drug poisoning, multiple neuritis, brain tumors, multiple sclerosis, or general paresis?

Drunken or Staggering Gait

What type of gait shows muscular dystrophies with weakness of the hips, patient rolls from side to side, and has a swaybacked or potbellied posture?

Waddling or Clumsy Gait

What type of gait is a high knee action and flopping of the foot where the toes tend to drag, commonly caused by alcoholic neuritis, peroneal nerve injury, poliomylitis, and progressive muscular atrophy?

Steppage Gait (footdrop gait)

What type of gait is associated with vertigo with a tendency to reel to one side and the lower extremities appear lose, with a wide-based, irregular, reeling with staggering on turning?

Cerebellar Gait or Ataxia

What type of gait is forward-leaning posture and short shuffling steps, beginning slowly at first and becoming more rapid as they try to chase their center of gravity?

Propulsion or Festination Gait

What type of gait simulates various paralyses and differs from the organic form in being more pronounced and complete, using the limb in an emergency, and gait is apt to be bizarre?

NOTE: what does apt mean? anterior pelvic tilt? apparent? who knows...

Hysterical Gait

What type of gait is a hysterical gait with such bizarre incoordination that the patient is unable to stand or walk, yet all leg movement can be done while the patient is sitting or lying in bed?

Astasia-Abasia

What type of gait occurs when pain is produced by weight-bearing on the lower extremity, getting the weight off the leg as soon as possible and having the good leg brought forward rapidly?

Limping Gait

What is compressed in thoracic outlet syndrome?

Subclavian Artery

How do you perform Allen's Test?

1) Patient seated w/ elbow flexed & palm supinated

2) Patient actively squeezes multiple times, making tight fist to pump blood out, then examiner occludes radial & ulnar artery at same time

3) Patient lowers/opens hand while Dr maintains occlusion of the radial/ulnar a. and the hand should look pale/blanched by ischemia

4) Examiner removes digital pressure from radial, assessing bloodflow

5) Ask if any pain?

6) Repeat process but instead of removing pressure from radial, remove from ulnar

Repeat on other side w/ other hand

How do you perform the Adson's test?

1) Patient seated w/ arms at sides and palms supinated

2) Examiner slighly abducts arm & palpates radial pulse

3) Patient rotates their head towards shoulder tested

4) Patient then extends neck & takes deep breath in & hold

5) Examiner palpates radial pulse, feeling for loss of amplitude

6) pain?

If there is a diminished pulse in Adson's test, what does this indicate?

Compression of subclavian artery between Scalenus Anticus & 1st Rib

How do you perform the Modified Adson's Test?

1) patient seated w/ arms at side and palms supinated

2) examiner slightly abducts arm & palpates radial pulse

3) patient rotates head towards shoulder OPPOSITE side being tested

4) patient then extends neck, takes deep breath in & hold

5) palpates radial pulse feeling for loss of pulse amplitude

6) pain?

If there is a diminished pulse in Modified Adson's Test, what does this indicate?

Compression of subclavian artery between Scalenous Medius & first rib

Adsons = between scalenous Anterior & rib 1

Modified adsons = between scalenous Medius & rib 1

How do you perform the Halstead's Test?

1) patient seated w/ arms at side & palm supinated

2) examiner slighly abduction the arm & palpates radial pulse

3) patient rotates head towards the shoulder OPPOSITE side being tested

4) patient extends neck adn takes deep breath in & hold

5) examiner applies downward traction on extremity while patient hyperextends neck

6) examiner pallpates radial pulse feeling for loss of amplitude

7) pain?

If there is a diminished pulse identified with Halstead's Test, what does this indicate?

Compression of subclavian artery between Scalenous Medius & first rib

(same as Modified Adson's test)

If Modified Adson's test was negative, but Halstead's test was positive, what could this be?

Saggy Shoulder Syndrome

How do you perform Allen's Maneuver?

1) patient seated

2) examiner palpates radial pulse

3) examiner abducts patients shoulder 90, the patients elbow flexed 90, and shoulders externally rotated

4) patient rotates head to OPPOSITE side

5) radial pulse assessed for loss of pulse amplitude

6) pain?

If a diminished pulse is identified in Allen's Maneuver, what could this indicate?

Compression of subclavian artery

How do you perform Roos' test?

1) patient seated w/ both arms abducted to 90 and externally rotated, elbows bent to 90

2) patient repeatedly opens & closes fists for 3 minutes

3) pain? radiate or localized?

What is a positive Roos test result?

Numbness/Tingling reproduced

Patient cannot keep shoulders abducted to 90 because pain, numbness, or tingling

Roos test was found to reproduce symptoms in ____% of patients with thoracic outlet syndrome?

91%

How do you perform Wright's Test (Hyper Abduction Maneuver)?

1) Patient seated w/ both arms hanging at sides

2) Examiner palpates radial pulse

3) Examiner passively abducts shoulder to 180

4) Note angle of abduction at which the radial pulse on the tested side diminishes or disappears

5) Repeat exam on opposite side (angle compared)

6) Pain?

When is Wright's Test considered positive?

Radial pulse diminishes at lower degree of shoulder abduction on symptomatic side than asymptomatic side

What does a Wright's Test positive indicate?

Compression of the axillary artery under pectoralis minor

How do you perform the Costoclavicular (Eden's) Test?

1) Patient seated w/ arms at side

2) Examiner palpates radial pulse

3) Examiner extends patients shoulder as patient pulls shoulders down & backwards and flexes cervical spine (chin to chest)

4) Assess loss of radial pulse amplitude

5) Pain?

What is a Costoclavicular test positive? What does this indicate?

Loss in amplitude of radial pulse

Indicates compression of subclavian artery between clavicle and first rib

What is the MC cause of a costoclavicular test positive which is loss of amplitude of radial pulse due to compression of subclavian artery between clavicle and first rib? What common activity of daily living may symptoms arise?

Old fractured clavicle

Wearing a backpack or heavy coat