II. Types
-
Upper Motor Neuron Lesion (everything is UP - tone, reflexes, toes)
- Muscle group weakness (not complete paralysis) and minimal Muscle atrophy
- Increased Muscle tone ("Clasp-knife" spasticity)
- Hyperreflexia with or without Clonus
- Babinski Reflex positive response
-
Lower Motor Neuron Lesion (everything is DOWN - tone, reflexes, toes)
- Flaccid Paralysis
- Muscular atrophy
- Muscle Fasciculations and fibrillations
- Hyporeflexia
- Absent Babinski Reflex
III. Exam: Muscle Strength Grading
- Grade 0: Total Paralysis
- Grade 1: Palpable or visible contraction
- Grade 2: Full range of motion with gravity eliminated
- Grade 3: Full range of motion against gravity
- Grade 4: Full range of motion with decreased strength
- Grade 5: Normal Strength
- NT: Not testable
IV. Exam: Rapid Motor Exam (Common and Important Motor deficits)
- Torso
- C3-4-5 keeps the diaphragm alive (Spontaneous Breathing)
- S2-3-4 keeps the stool off the floor (Reflex Defecation Center)
- Upper extremity
- Radial Nerve (C5-C6, C7-C8): Wrist Drop
- Dorsiflexion wrist, fingers against resistance (extensor carpi radialis, extensor digitorum)
- Median Nerve (C7, C8, T1): Cannot make 'OK' Sign
- Opposition of thumb and index finger against resistance
- Ulnar Nerve (C8-T1): Claw Hand
- Finger abduction against resistance
- Radial Nerve (C5-C6, C7-C8): Wrist Drop
- Lower extremity
V. Exam: Upper Extremity Strength
-
- C3-5: Spontaneous Breathing ("C3-4-5 keeps the diaphragm alive")
- C3-4: Trapezius function
- C5: Shoulder External Rotation (Infraspinatus)
- C5: Deltoid and Supraspinatus abduction at Shoulder (Axillary Nerve)
- C5-6: Biceps Flexion at Forearm (Musculocutaneous Nerve)
- C6: Forearm Supination (Radial Nerve)
- C6-7: Forearm Pronation (Pronator Teres; Median Nerve)
- C6-7: Wrist Extension (extensor carpi radialis brevis and longus; Radial Nerve)
- C7: Wrist Flexion (flexor carpi radialis brevis and flexor carpi ulnaris; Median Nerve and Ulnar Nerve)
- C7: Elbow Extension (Triceps, Radial Nerve)
- C7-8: Finger Extension (Extensor digitorum, extensor indicis, extensor digiti minimi; Radial Nerve - posterior interosseous)
- C7-8: Thumb Abduction (Abductor Pollicis Longus; Radial Nerve - posterior interosseous)
- C8: Thumb Extension and Adduction
- C8: Wrist Extension and incline ulnar aspect of hand (Extensor Carpi Ulnaris)
- C8: Fingers Flexion middle finger (flex dig profundus, Median Nerve)
- C8-T1: Thumb Flexion (flexor pollicis longus, Median Nerve - anterior interosseous)
- T1: Small finger abductors (abductor digiti minimi)
- T1: Finger abuction or spread fingers (Interosseus intrinsic Hand Muscles, Ulnar Nerve)
VI. Exam: Lower Extremity Strength
- L2-3: Hip flexors (Iliopsoas Muscle, femoral nerve)
- L2-4: Hip Adduction (obturator nerve)
- L3-4: Knee Extension (Quadriceps Muscles, femoral nerve)
- L4: Ankle dorsiflexion (tibialis anterior Muscle, deep peroneal nerve)
- L4: Foot Inversion (Anterior tibial nerve)
- L4-S1: Hip Abduction (superior gluteal nerve)
- L5-S2: Hip Extension (Gluteus maximus, inferior gluteal nerve)
- L5: Hip Extension (inferior gluteal nerve)
- L5: Weak Heel Walking, Foot Drop (deep peroneal nerve)
- L5: Great toe extension (Extensor hallucis longus Muscle)
- L5: Foot dorsiflexion (Extensor digitorum longus Muscle)
- S1: Knee Flexion (sciatic nerve)
- S1: Ankle plantar flexion (Gastrocnemius and Soleus Muscles, tibial nerve)
- S1: Toe Walking
- S1: Foot Eversion
- S2-4: Reflex Defecation Center ("S2-3-4 keeps the stool off the floor")
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Related Studies
| Concepts | Embryonic Structure (T018) |
| SnomedCT | 5898009 |
| English | myotome, myotomes, Myotome, Structure of myotome (body structure), Structure of myotome, Myotome, NOS |
| Spanish | estructura del miótomo (estructura corporal), estructura del miótomo, miótomo |
Ontology: Motor testing (C0430740)
| Concepts | Diagnostic Procedure (T060) |
| SnomedCT | 164837008, 141998009, 34118006 |
| English | Musculo-skeletal test NOS, motor test, motor tests, motor testing, Musculo-skeletal test NOS (procedure), Locomotor test, Motor testing (procedure), Motor testing, Motor testing, NOS |
| Spanish | prueba para el sistema musculoesquelético, SAI, prueba para el sistema musculoesquelético, SAI (procedimiento), Musculo-skeletal test NOS, prueba musculoesquelética, SAI, examen motor (procedimiento), examen motor |
Ontology: Motor nerve (C0501384)
| Definition (FMA) | General anatomical term applied to nerves in which somatic efferent nerve fibers predominate. |
| Concepts | Body Part, Organ, or Organ Component (T023) |
| English | Motor nerve, Nervus motorius, motor nerves, motor nerve, nerve motor |
Ontology: Muscle Strength (C0517349)
| Definition (MSHCZE) | Síla vytvořená svalovou kontrakcí (SVALY – KONTRAKCE). Svalová síla může být změřena v průběhu izometrické, izotonické nebo izokinetické kontrakce svalu buď manuálně nebo zařízením na měření SVALOVÉ SÍLY – DYNAMOMETRem. R |
| Definition (CSP) | force exerted by a muscle, as a response parameter (e.g. bioassay) or as an indicator of health, endurance, fitness, etc. |
| Definition (MSH) | The amount of force generated by MUSCLE CONTRACTION. Muscle strength can be measured during isometric, isotonic, or isokinetic contraction, either manually or using a device such as a MUSCLE STRENGTH DYNAMOMETER. |
| Concepts | Organ or Tissue Function (T042) |
| MSH | D053580 |
| English | Muscle strength, Muscle Strength, Strength, Muscle, muscle strength, strength muscle |
| Portuguese | Força Muscular |
| Spanish | Fuerza Muscular |
| Russian | МЫШЦЫ СИЛА, МЫШЕЧНАЯ СИЛА, MYSHECHNAIA SILA, MYSHTSY SILA |
| Italian | Forza muscolare |
| German | Muskelkraft |
| French | Force musculaire, Force du muscle |
| Swedish | Muskelstyrka |
| Finnish | Lihasvoima |
| Czech | svaly - síla, svalová síla |
| Polish | Siła mięśni, Wytrzymałość mięśni |
| Croatian | Mišićna snaga |
| Norwegian | Muskelstyrke, Muskelkraft |
Ontology: Motor root (C2339332)
| Concepts | Classification (T185) |
| English | Motor root |
