Motor Examination

Motor Examination
 Always Compare
 Ask about pain which may interfere with testing.
 As a quick review (motor examination)composed of: inspection →tone→ power →reflex
What to examine How to do it

Inspection ▪ Scars, striae, swelling, dilated vein
▪ Abnormal position e.g: Hemiplegia,Mask face,
▪ Abnormal movement, e.g. :tremor or drifting.
▪ Muscle wasting
▪ Deformity, e.g. :Wrist or foot drop,Claw hand.
▪ Fasciculations
Tone 1)on supine position,ask the pt to RELAX

2)Move his\her big joints passively through the range of motions,start from upper limb distal then proximal or vasa
versa:
 For upper limb [pronate & supinate the hand→flex & extend the wrist→flex & extend the
elbow→abduct & adduct the shoulder]
 For lower limb[ flex & extend the ankle→flex & extend the knee→flex & extend the hip]
Power 1) Pt position: for upper limb power :sitting |For lower limb power :supine.
2)Test the muscle strength of upper \lower limb by asking the pt to do: ‫اقوله يسوي هالحركات وأنا احاول اعكس حركته بيدي‬
,‫كت‬ ‫كت! ي‬
‫اب اشوف قد ايش عضالته قوية وبتقدر تقاوم حر ي‬ ‫واقوله حاول تقاوم حر ي‬
UPPER LIMB
Shoulder abduction
Elbow flexion Elbow extension
Wrist extension
Finger extension Finger flexion Finger abduction Thumb
abduction
LOWER LIMB
Hip flexion Hip extension
Knee flexion Knee extension
Ankle dorsiflexion Ankle plantar Great toe extension Ankle eversion Ankle inversion
flexion
3) Compare muscle strength on both sides, and grade it on the MRC Scale:
To test truncal strength ‫اعرفوها عشان تصيروا فنانين اذا سألوكم‬

ask the patient to sit up from the lying position, or rise from a chair,
without using the arms
4)pronator drift: Observe the patient with his arms outstretched and
supinated(palms up) and eyes closed for ‘pronator drift’, when one arm starts to
pronate .
*Pronator drift is an early feature of an upper motor neurone lesion
Right cerebral lesion:left side finding
Reflex 1)Ask the patient to lie supine with the limbs exposed. He should be as relaxed and comfortable as possible,
2)Strike the tendon,not the muscle or bone ‫]فمهم تعرفون تحددون مكان التندون بالزبط‬
(Deep tendon Testing the deep tendon reflexes of the upper limb:
reflexes) Eliciting the biceps jerk, C5. Triceps jerk, C7. Supinator jerk, C6.
‫هالنقطه ماتكلموا عنها الدكاتره وماظن مهمه بس لقيتها بالكتاب وخفت يكون عليها درجات بالتشيك ليست‬
Testing the deep tendon reflexes of the hand.
Hoffmann’s sign. Eliciting a finger
‫امسك يد المريض نفس‬, ‫بهوفمن ساين‬
jer
)‫الصورة(يد االقزانر هي السمراء‬
‫واقوم اخذ االصبع االوسط وأفرك ظفره‬
‫طبيعيا بيصير ردة الفعل‬, ‫رايحه جايه‬
Adduction of the thumb and
flexion of the index
Testing the deep tendon reflexes of the lower limb:

Eliciting the knee jerk (note that the legs should not Ankle jerk , S1
be in contact with each other), L3, L4.
3)Record the response as:increased-normal-diminished present only with reinforcement-absent.
4)Use reinforcement whenever a reflex appears absent:

→ To reinforce Lower limb reflexes:ask the patient to interlock the fingers and pull one hand against
the other, immediately before you strike the tendon (Jendrassik’s manoeuvre). ‫ال بالصورة عجنب‬
‫نفس ي‬
→ To reinforce upper limb reflexes:ask the patient to clench the teeth or to make a fist with the
contralateral hand.
Reflex Plantar response (S1–2)

(Superficial → How to do it: ‫وامش به عىل باطن القدم بنفس اتجاه السهم يال بالصوة‬
‫ي‬ ‫ش حاد زي مفتاح السيارة وال طرف الهامر‬
‫خوذوا ي‬
reflexes)
→ Abnormal findings :An abnormal plantar response is extension of the large toe (extensor plantar or Babinski response).
This is a sign of upper motor neuron damage and is usually associated with other upper motor neurone signs, e.g.
spasticity,lonus and hyperreflexia. Fanning of the toes is normal and not pathological.
Abdominal reflexes (T8–12) not imp just mention it

→ How to do it: The patient should be supine and relaxed. Use an orange stick and briskly, but lightly,
stroke the upperand lower quadrants of the abdomen in a medial direction.The normal response is
contraction of the underlying muscle,
→ Abnormal findings :Superficial abdominal reflexes (T8–12) are lost in upper motor neurone lesions
but are also affected by lower motor neurone damage affecting T8–12. Usually absent in the obese
For males Cremasteric reflex (L1–2): not imp just mention it

→ How to do it:Abduct and externally rotate the patient’s thigh.the upper medial aspect of the thigh.Normally the testis on
the side stimulated will rise .
→ Abnormal findings :The cremasteric reflex in males (L1 and L2) is rarely elicited, but typically is lost in spinal cord or root
lesions.
NOTE:
 If they ask you in the osce to do upper limp examination do It in this way:motor examination sensory
examinationcoordination
 If they ask you in the osce to do upper limp examination do It in this way:motor examination sensory
examinationcoordination Gait
 The details of each examination have been discussed separately

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What to examine How to do it

Tone 1)on supine position,ask the pt to RELAX

To test truncal strength ‫اعرفوها عشان تصيروا فنانين اذا سألوكم‬

Testing the deep tendon reflexes of the lower limb:

3)Record the response as:increased-normal-diminished present only with reinforcement-absent.

4)Use reinforcement whenever a reflex appears absent:

Reflex Plantar response (S1–2)

Abdominal reflexes (T8–12) not imp just mention it

For males Cremasteric reflex (L1–2): not imp just mention it

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