Upper limb Neurological Examination

Presentation on theme: "Upper limb Neurological Examination"— Presentation transcript:

1 Upper limb Neurological Examination
馬偕醫院神經科 李卓育醫師

2 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

3 Inspection muscle atrophy fasciculation involuntary movement

4 Muscle Tone spasticity (pyramidal) rigidity (extra-pyramidal)

5 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

6 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

7 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

8 Reflexes Grading of reflexes 0 = absent 1+ = reduced (hypoactive)
2+ = normal 3+ = increased (hyperactive), brisk 4+ = clonus

9 Deep tendon reflexes: 上肢
Biceps stretch reflex C5C6/ musculocutaneous n.

10 Deep tendon reflexes: 上肢
Brachioradialis stretch reflex C5C6/ radial nerve

11 Deep tendon reflexes: 上肢
Triceps stretch reflex C7C8/ radial nerve

12 Deep tendon reflexes: 上肢
Hoffman sign corticospinal dysfunction

13 Coordination finger-nose-finger test rebound phenomenon
rapid alternative movements (dysdiadochokinesia)

14 Sensation light touch Pinprick Proprioception vibration (128Hz)