Motor function examination of basic clinical skills and nervous system examination

In clinical work, the commonly used routine physical examinations are very important.
The various positioning and qualitative diagnosis of neurology is very important for the diagnosis of diseases.
Today we will explain the examination of motor function
.

In clinical work, the commonly used routine physical examinations are very important.
The various positioning and qualitative diagnosis of neurology is very important for the diagnosis of diseases.
Today we will explain the examination of motor function
.

diagnosis

Movement includes voluntary and involuntary movements, voluntary movements are managed by the pyramidal tract, and involuntary movements (involuntary movements) are managed by the extravertebral system and the cerebellum
.

 

Movement includes voluntary and involuntary movements, voluntary movements are managed by the pyramidal tract, and involuntary movements (involuntary movements) are managed by the extravertebral system and the cerebellum

1.

Observe, touch, the muscular shape and volume of bilaterally symmetrical limbs, trunk and face, whether there is muscle atrophy, pseudohypertrophy and its distribution range

Second, muscle tension two, muscle tension tension

Refers to the muscle tension in the resting state, judged by the hardness of the touch muscle and the resistance felt when the limbs are stretched and flexed
.

Refers to the muscle tension in the resting state, judged by the hardness of the touch muscle and the resistance felt when the limbs are stretched and flexed
.

1.
Increased muscle tone : The muscles are firm, and the resistance increases when the limbs are stretched and flexed
.

1.
Increased muscle tone 1.
Increased muscle tone : The muscles are firm, and the resistance increases when they stretch and flex their limbs
.

2.
Muscle tension is reduced : the muscles are soft, the resistance is low when the limbs are stretched and flexed, and the range of joint motion is expanded
.

2.
Reduced muscle tone 2.
Reduced muscle tone : The muscles are soft, the resistance is low when the limbs are stretched and flexed, and the range of joint motion is expanded
.

Three, muscle strength

Three, muscle strength

It refers to the maximum contraction force of the muscles when the patient actively exercises.
Generally, the extension, flexion, adduction, abduction, pronation and supination of the muscles are checked with the joint as the center, and attention should be paid to the contrast between the two sides
.

 

It refers to the maximum contraction force of the muscles when the patient actively exercises.

1.

Level 0: Completely paralyzed;

Level 1: The muscles can contract, but cannot produce movements;

Level 1: The muscles can contract, but cannot produce movements;

Level 2: The limbs can move on the bed, cannot be lifted, that is, they cannot resist their own gravity;

Level 2: The limbs can move on the bed, cannot be lifted, that is, they cannot resist their own gravity;

Level 3: Limbs can resist gravity to leave the bed surface, but cannot resist resistance;

Level 3: Limbs can resist gravity to leave the bed surface, but cannot resist resistance;

Level 4: The limbs can perform resistance movements but are not complete;

Level 4: The limbs can perform resistance movements but are not complete;

Grade 5: Normal muscle strength
.

Grade 5: Normal muscle strength
.

Note: During the examination, the restriction of movement due to pain, joint stiffness, or hypertension must be excluded
.

Note: During the examination, the restriction of movement due to pain, joint stiffness, or hypertension must be excluded
.

2.
Paresis inspection method :

2.
Paresis inspection method 2.
Paresis inspection method :

Upper limbs: 

Upper limbs: 

Flat lift test: Raise both upper limbs horizontally, palms down, and the upper limbs on the paralyzed side gradually droop and pronation (palm outwards)
.

Flat lift test: Raise both upper limbs horizontally, palms down, and the upper limbs on the paralyzed side gradually droop and pronation (palm outwards)
.

Lower limbs:

Lower limbs:

1) Jackson’s sign: the legs are straight in the supine position, and the lower limbs on the paralyzed side are often in an external rotation position;

1) Jackson’s sign: the legs are straight in the supine position, and the lower limbs on the paralyzed side are often in an external rotation position;

2) Knee sagging test (Magazini test): lying on the back, both knees and hip joints are flexed at right angles, and the lower leg of the paralyzed side gradually drops
.

2) Knee sagging test (Magazini test): lying on the back, both knees and hip joints are flexed at right angles, and the lower leg of the paralyzed side gradually drops
.

 

 

Four, mutual aid movement

4.
Mutual aid movement 4.
Mutual aid movement

The completion of any movement of the body depends on the coordinated movement of a certain group of muscles.
This coordination mainly depends on the function of the cerebellum.
The vestibular nerve, the optic nerve, the deep sensory and the extrapyramidal system are all involved
.

The completion of any movement of the body depends on the coordinated movement of a certain group of muscles.
This coordination mainly depends on the function of the cerebellum.
The vestibular nerve, the optic nerve, the deep sensory and the extrapyramidal system are all involved
.

1.
Finger nose test

1.
Finger nose test 1.
Finger nose test

Instruct the patient to abduct one upper limb, touch the tip of his nose with the straight fingertip, repeat it with different directions, speeds, open and close eyes, and compare the two sides
.

Instruct the patient to abduct one upper limb, touch the tip of his nose with the straight fingertip, repeat it with different directions, speeds, open and close eyes, and compare the two sides
.

Clinical significance: Inaccuracy of the ipsilateral finger and nose-cerebellar hemisphere disease
.
When the eyes are opened, the finger and nose are accurate, and when the eyes are closed, there is an obstacle-sensory ataxia
.

Clinical significance: Inaccuracy of the ipsilateral finger and nose-cerebellar hemisphere disease
.
When the eyes are opened, the finger and nose are accurate, and when the eyes are closed, there is an obstacle-sensory ataxia
.

 

 

 

 

 

2.
Quick-return rotation test 

2.
Quick-return rotation test 2.
Quick-return rotation test 

The examinee makes rapid pronation and supination with the forearm, or continuously and alternately pats the back of the opposite hand with the palm of one hand and the back of the hand, or repeatedly and quickly slams the ground with the toes
.

The examinee makes rapid pronation and supination with the forearm, or continuously and alternately pats the back of the opposite hand with the palm of one hand and the back of the hand, or repeatedly and quickly slams the ground with the toes
.

Clinical significance: Patients with cerebellar ataxia have clumsy movements, slow and uncoordinated rhythms
.

Clinical significance: Patients with cerebellar ataxia have clumsy movements, slow and uncoordinated rhythms
.

3.
Heel knee shin test

3.
Heel knee shin test 3.
Heel knee shin test

The patient takes the supine position, raises one lower limb to a certain height, puts the heel on the opposite knee, and then moves down along the front edge of the tibia
.

The patient takes the supine position, raises one lower limb to a certain height, puts the heel on the opposite knee, and then moves down along the front edge of the tibia
.

Clinical significance: When the cerebellum is damaged, the movement is inaccurate; when the eyes are closed, the movement disorder appears in the sensory ataxia
.

Clinical significance: When the cerebellum is damaged, the movement is inaccurate; when the eyes are closed, the movement disorder appears in the sensory ataxia
.

4.
Bounce test

4.
Bounce test 4.
Bounce test

The patient is instructed to flex the elbow forcefully.
The examiner holds his wrist and exerts force in the opposite direction, and then suddenly releases his hand.
Due to the antagonistic effect of the antagonist muscle, the normal person can immediately stop the forearm flexion
.

The patient is instructed to flex the elbow forcefully.
The examiner holds his wrist and exerts force in the opposite direction, and then suddenly releases his hand.
Due to the antagonistic effect of the antagonist muscle, the normal person can immediately stop the forearm flexion
.

Clinical significance: Due to the lack of such antagonism in patients with cerebellar disease, the flexed forearm can counterattack their body
.

Clinical significance: Due to the lack of such antagonism in patients with cerebellar disease, the flexed forearm can counterattack their body
.

5.
Sit-up test

5.
Sit-up test 5.
Sit-up test

Take a supine position, cross your hands on your chest, sit up without support, normal people flex their trunks and press their legs down.
Patients with cerebellar lesions flex their trunks and hips at the same time, and lift their lower limbs off the bed, making it difficult to sit up.
Called the joint flexion sign
.

Take a supine position, cross your hands on your chest, sit up without support, normal people flex their trunks and press their legs down.
Patients with cerebellar lesions flex their trunks and hips at the same time, and lift their lower limbs off the bed, making it difficult to sit up.
Called the joint flexion sign
.

6.
Close your eyes and make a move

6.
It is difficult to enlist with closed eyes 6.
It is difficult to enlist with closed eyes

The subject stood with feet and eyes closed, hands stretched forward and eyes closed
.

The subject stood with feet and eyes closed, hands stretched forward and eyes closed
.

Clinical significance: If you can stand firm when you open your eyes but you can't stand when you close your eyes, it is sensory ataxia, called Romberg's sign (+)
.
The wide open eyes closed eyes are unstable, eyes closed more apparent, suggesting cerebellar lesions, vermis recline lesions, lesions of the cerebellum is tilted to the side of the disease
.

Clinical significance: If you can stand firm when you open your eyes but you can't stand when you close your eyes, it is sensory ataxia, called Romberg's sign (+)
.
The wide open eyes closed eyes are unstable, eyes closed more apparent, suggesting cerebellar lesions, vermis recline lesions, lesions of the cerebellum is tilted to the side of the disease
.

 

 

Five, involuntary movement 

5.
Involuntary movement 5.
Involuntary movement 

Some purposeless abnormal movements produced by the contraction of voluntary muscles are mostly manifestations of extrapyramidal damage
.

Some purposeless abnormal movements produced by the contraction of voluntary muscles are mostly manifestations of extrapyramidal damage
.

1.
Tremor : Two groups of involuntary movements caused by the alternating contraction of the antagonist muscles can have the following types: resting tremor, action tremor, and senile tremor
.

1.
Tremor 1.
Tremor : Two groups of involuntary movements caused by the alternating contraction of the antagonist muscles can have the following types: resting tremor, action tremor, and senile tremor
.

2.
Dance-like movements : fast, purposeless, asymmetrical movements of the large joints of the limbs, similar to dance, which can be reduced or disappeared during sleep
.
This movement can also occur on the face, just like making a face, and is more common in childhood rheumatic diseases
.

2.
Dance-like movements 2.
Dance-like movements : fast, purposeless, asymmetrical movements of the large joints of the limbs, similar to dance, which can be reduced or disappeared during sleep
.
This movement can also occur on the face, just like making a face, and is more common in childhood rheumatic diseases
.
child

3.
Athletes : Cerebral Palsy, Hepatolenticular Degeneration, and Cerebral Basal Ganglia Degeneration
.
Tetany: hypocalcemia and so on
.

3.
Slow movement of hands and feet 3.
Athletes : Cerebral Palsy, Hepatolenticular Degeneration, and Cerebral Basal Ganglia Degeneration
.
Tetany: hypocalcemia and so on
.

 

 

Six, posture and gait changes 

Six, posture  and gait changes 

Observe the patient's sitting, lying, standing and walking for any abnormalities
.

Observe the patient's sitting, lying, standing and walking for any abnormalities
.

Points to note: In addition to the cerebellum related to mutual aid exercises, vision and deep sensation are involved.
Therefore, you should open your eyes and close your eyes once during the examination.
For those with decreased muscle strength, abnormal muscle tone and involuntary movement, the significance of this examination Not big
.
 

Points to note: In addition to the cerebellum related to mutual aid exercises, vision and deep sensation are involved.
Therefore, you should open your eyes and close your eyes once during the examination.
For those with decreased muscle strength, abnormal muscle tone and involuntary movement, the significance of this examination Not big
.
 

To sum up, the exercise system examination mainly includes muscle nutrition status, muscle strength and muscle tension examination, mutual aid exercise, involuntary exercise and abnormal posture and gait.
The summary memory formula is as follows :

To sum up, the exercise system examination mainly includes muscle nutrition status, muscle strength and muscle tension examination, mutual aid exercise, involuntary exercise and abnormal posture and gait.
The summary memory formula is as follows :

 

 

  Exercise system check memory mantra (order: from top to bottom-from left to right)

  Exercise system check memory mantra (order: from top to bottom-from left to right)

 

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