Upper limb Neurological Examination 馬偕醫院神經科 李卓育醫師
自我介紹並解釋檢查目的 確認病人身份 接觸病人前洗手 Inspection Muscle tone Muscle power Deep tendon reflex Coordination Sensation 接觸病人後洗手
Inspection muscle atrophy fasciculation involuntary movement
Muscle Tone spasticity (pyramidal) rigidity (extra-pyramidal)
Muscle Power Medical Research Council (MRC) scale 0 = no contraction 1 = visible muscle twitch but no movement of the joint 2 = weak contraction insufficient to overcome gravity 3 = weak contraction able to overcome gravity but no additional resistance 4 = weak contraction able to overcome some resistance but not full resistance 5 = normal; able to overcome full resistance
Muscle Power Pronator drift Shoulder abduction, elbow flexion, elbow extension, wrist flexion, wrist extension, finger flexion, finger extension, finger adduction, thumb abduction, little finger abduction
如何握神經槌 選擇槌頭重,槌柄長的神經槌 用手指輕握槌柄(掌心不要握實),用手腕的力量很輕快的將槌頭”甩“在受試者肌腱上 重點是下垂的加速度
Reflexes Grading of reflexes 0 = absent 1+ = reduced (hypoactive) 2+ = normal 3+ = increased (hyperactive), brisk 4+ = clonus
Deep tendon reflexes: 上肢 Biceps stretch reflex C5C6/ musculocutaneous n.
Deep tendon reflexes: 上肢 Brachioradialis stretch reflex C5C6/ radial nerve
Deep tendon reflexes: 上肢 Triceps stretch reflex C7C8/ radial nerve
Deep tendon reflexes: 上肢 Hoffman sign corticospinal dysfunction
Coordination finger-nose-finger test rebound phenomenon rapid alternative movements (dysdiadochokinesia)
Sensation light touch Pinprick Proprioception vibration (128Hz)