Cheatography
https://cheatography.com
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This is a draft cheat sheet. It is a work in progress and is not finished yet.
Introduction:
W |
Wash Hands |
I |
Introduce Yourself + Patient's Identity |
P |
Permission |
P |
Patient Position + Pain |
E |
Explaination |
Patient must be placed at 45° and limbs exposed
Equipment:
|
Cotton Wool Neurotips Tendon Hammer 128Hz Tuning Fork |
General Inspection:
•Postural abnormalities and deformities |
•Leaning or facial asymmetry |
•Muscle wasting, fasciculations, or tremor |
•Abnormal movements |
•Obvious discomfort or pain |
•Medical paraphernalia: |
Walking aids, Calipers |
Ask patient to lean forward and examine back/scapulae
Tone:
Check for pain before starting |
Check tone: |
Ask patient to rotate arm at shoulder
Flex and extend arms at elbow
Supination and pronation
Flex and extend hand at wrist |
Extra movement => Decreased tone
Less movement => Rigidity |
Increased Tone:
• Clasp knife rigidity
• Clonus
• Cog wheeling
• Lead pipe rigidity
Decreased Tone:
• lower motor neuron lesion
Power:
Test both left and right limbs, directly comparing each movement in turn.
The patient should perform each movement on their own and then attempt with the examiner resisting the movement |
Pronator Drift: |
Ask patient to stretch both arms out in front of them with their eyes closed and palms facing upwards. |
Indication of muscle weakness, abnormal function of the corticospinal tract and upper motor neurons |
Shoulders: |
Abduction + Adduction |
Ask patient to "Chicken Wing" and push up/down against your hands |
Elbows: |
Flexion + Extension |
Ask patient to flex/extend arm towards/away from you |
Wrist: |
Flexion + Extension |
Hands out with closed fist, resist pushing up/down |
Fingers: |
Flexion + Extension
Adduction + Abduction |
Hands out with fingers straight, resist pushing up/down
Hands out, spread fingers apart, resist pushing fingers together
Close fingers, resist pulling apart individually |
Thumb: |
Adduction |
Patient holds out hand, resists pushing towards other fingers.
Patient forms ring with thumb and pointer finger and resists opening ring |
Coordination:
Finger to Nose Test: |
Past pointing, Kinetic Tremor |
Rapidly alternating wrist movements: |
Supination + Pronation - Dysdiadochokinesia |
Tendon Reflexes:
Limb must be totally relaxed |
Biceps: |
Support patient's arm on yours |
C5,6 |
Triceps: |
Allow patients arm to hang with elbow at 90° |
C7 |
Brachioradialis: |
Strike 2-3cm above the radial styloid process |
C5,6 |
Muscle may just contract, may not be an obvious movement
Reflex may be present/absent, or reduced/brisk
Sensation:
Light Touch: |
Important to touch rather then stroke
Lightly touch sternum first using cotton wool. Ask patient to close eyes and tell you when they feel the touch. Ask if touch feels the same on both sides |
|
Posterior aspect of the shoulders |
C4 |
|
Lateral aspect of the upper arms |
C5 |
|
Tip of the thumb |
C6 |
|
Tip of the middle finger |
C7 |
|
Tip of the little finger |
C8 |
|
Medial aspect of the lower arms |
T1 |
|
Medial aspect of the upper arms |
T2 |
Pain: |
Repeat same process as for light touch.
Tested using a new neurotip. Must be disposed of in the sharps bin. |
Temperature: |
Tested the same way as pain/light touch, rarely done.
Tested using a cold tuning fork. |
Vibration Sense: (128Hz) |
Strike tuning fork and hold to patient's sternum. Ask patient to close eyes. |
|
Begin on most distal bony prominance (Tip of middle finger, working proximally on each bony prominance) |
Proprioception: |
Hold middle finger at middle phalanx, ask patient to close eyes.
Demonstrate up/down for the patient, then repeat in a random direction, asking the patient to say which direction the toe is moving.
Repeat 3 times for both sides.
Continue up finger/arm until patient is correct |
Upper Limbs Dermatome Map:
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