Peripheral Nerves Examination

Give 6 things to look at for when taking general observations of a patient before starting the peripheral nerves examination:

1) muscle wasting

2) fasciculation

3) posture

4) movement abnormality

5) involuntary movement

6) gait

What should you ask the patient before beginning the peripheral nerve examination?

are you experiencing any pain at the moment?

Describe how to assess tone in the lower limb?

roll each leg gently and observe foot movement and then flex the patients knee and ankle

Give three potential causes of increased muscle tone:

1) upper motor neurone disorders causing spasticity

2) disorders of the basal ganglia causing rigidity

3) Parkinson's disease causing rigidity

Name one potential cause of decreased muscle tone:

lower motor neurone or cerebellar lesions

Give the four sets of joint movements used to assess muscle power in the lower limb:

1) hip flexion, extension, abduction and adduction

2) knee flexion and extension

3) ankle dorsiflexion and plantarflexion

4) big toe flexion and extension

True or false: when assessing power of muscles, you should repeat each movement with applied resistance

true

List the 6 tests used to assess lower limb coordination:

1) Heel-shin test

2) Toe tapping

3) Patella reflex

4) Ankle jerk

5) Plantar reflex

6) Clonus

Describe the heel-shin test:

ask the patient to place their left heal on their right knee and then run the left heal towards their right foot and repeat quickly - then repeat on the other side

What spinal nerves are tested in the patella reflex?

L3/L4

What spinal nerves are tested in the ankle jerk?

S1/S2

Describe how to carry out the plantar reflex:

scratch the sole of the foot moving from the heel to the toes - the big toe should flex

What does extension of the big toe in the plantar reflex indicate?

upper motor lesion

What is the clonus reflex?

Clonus is a type of neurological condition that creates involuntary muscle contractions - uncontrollable, rhythmic, shaking movements

Describe how to test the clonus reflex:

suddenly dorsiflex the ankle and hold it in position, checking for rhythmic contraction of the gastrocnemius muscle

List the four tests used to assess lower limb sensation:

1) soft touch (cotton wool) on each dermatome

2) sharp touch (neuro tip) on each dermatome

3) proprioception at the DIP joint

4) vibration sense test

Describe how to test proprioception at the DIP joint of the big toe:

move it up and down, and ask for patient to identify the direction of the movement

What should you do if a patient fails the proprioception test at the DIP joint?

repeat at a more proximal joint

Describe how to test vibration sense in the lower limb:

apply a vibrating tuning fork to the DIP joint of the big toe - ask the patient to identify when the vibrations begin and stop

Where is the reference vibration given in the vibration sense test?

sternum

Describe how to assess tone in the upper limb:

hold the patients hand as if to shake it, then flex and extend their risk, elbow, supinate and pronate the forearm and rotate the shoulder

Describe how pronator drift test used to asses power of the upper limbs:

ask patient to extend their arms with palms facing upwards, ask them to close their eyes

What does falling of the arms in the pronator drift test indicate?

upper motor lesion

List the 5 sets of joint tests used to assess power of the upper limbs:

1) shoulder abduction and adduction

2) elbow flexion and extension

3) wrist flexion and extension

4) finger adduction, abduction, flexion and extension

5) thumb adduction and abduction

List the five tests used to assess coordination of the upper limbs:

1) finger nose test

2) dysdiadokokinesia test

3) supinator reflex

4) biceps reflex

5) triceps reflex

Describe how to test for dysdiadokokinesia:

have patients hold their palms up , place the other palm on top and repeatedly turn the top hand back and forth

What spinal nerves does the supinator reflex test?

C5/C6

What spinal nerves does the biceps reflex test?

C5/C6

What spinal nerves does the triceps reflex test?

C6/C7

List the four tests used to assess sensation in the upper limb:

1) soft touch test

2) sharp touch test

3) proprioception test at DIP joint of index finger

4) vibration sense test at DIP joint of index finger