Upper vs Lower Motor Neuron Lesions
- flexion/extension, pronation/supination of joint through its ROM
- LMN lesions, spinal shock, cerebellar lesions-flaccidity
- Spasticity - UMN lesion. Pyramidal tract involved
- limb moves, then catches, and then goes past catch (clasp-knife)
- test by rapidly supinating forearm
- Rigidity
- UMN lesions, extrapyrimidal tract lesion
- increased tone throughout ROM (cog-wheeling, lead-pipe)
- circumducting the wrist
- UMN
- flexors > extensors in upper limbs
- extensors > flexors in lower limbs
- LMN
- reduced power in specific motor neuron distribution
- deltoids - arm abduction - C5 C6 (axillary)
- biceps - elbow flexion - C5 C6 (musculocutaneous)
- triceps - elbow extension - C6 C7 C8 (radial)
- thumb flexion - C6 C7 (median)
- wrist extensors - C7 C8 (radial)
- interossei of hand - finger abduction/adduction - C8 T1 (ulnar)
- hip flexion - L1 L2 L3 (femoral)
- hip adduction - L2 L3 L4 (obturator)
- hip abduction - L4 L5 S1 (superior gluteal)
- knee extension - L2 L3 L4 (femoral)
- knee flexion - L5 S1 S2 (sciatic)
- ankle dorsiflexion - L4 L5 (deep peroneal)
- ankle plantar flexion - S1 S2 (tibial)
- foot inversion - L4 L5 (posterior tibial)
- foot eversion - L5 S1 (superficial peroneal)
- compare between L and R
- GRADE
- 0 nil
- 1 flicker of movement
- 2 movement cannot overcome gravity
- 3 movement cannot overcome any resistance
- 4 movement is weaker than normal
- 5 normal
- have the patient stand with eyes closed and arms held straight out and hands supinated
- + → patient cannot maintain this position
- muscle weakness (pronation and outward drift)
- UMN lesion (pronation and downward drift)
Fine Finger Movements
edit
- ask patient to touch each finger to crease of thumb (show patient how) and speed it up
- look for right and left differences, slow if UMN lesion
- Ankle or Patellar clonus in UMN Lesion
