Motor Exam

Aka: Motor Exam, Strength Grading, Muscle Strength, Myotomes, Motor Nerve, Motor Root, Motor Neurons, Motor Strength, Rapid Extremity Motor Exam

1. See Also
   1. Upper Motor Neuron Lesion
   2. Lower Motor Neuron Lesion
   3. Sensory Exam
   4. Deep Tendon Reflex
2. Types
   1. Upper Motor Neuron Lesion (everything is UP - tone, reflexes, toes)
      1. Muscle group weakness (not complete paralysis) and minimal muscle atrophy
      2. Increased muscle tone ("Clasp-knife" spasticity)
      3. Hyperreflexia with or without Clonus
      4. Babinski Reflex positive response
   2. Lower Motor Neuron Lesion (everything is DOWN - tone, reflexes, toes)
      1. Flaccid Paralysis
      2. Muscular atrophy
      3. Muscle fasciculations and fibrillations
      4. Hyporeflexia
      5. Absent Babinski Reflex
3. Exam: Muscle Strength Grading
   1. Grade 0: Total Paralysis
   2. Grade 1: Palpable or visible contraction
   3. Grade 2: Full range of motion with gravity eliminated
   4. Grade 3: Full range of motion against gravity
   5. Grade 4: Full range of motion with decreased strength
   6. Grade 5: Normal Strength
   7. NT: Not testable
4. Exam: Rapid Extremity Motor Exam (Common Extremity Motor deficits)
   1. Upper extremity
      1. Radial Nerve (C5-C6, C7-C8): Wrist Drop
         1. Dorsiflexion wrist, fingers against resistance (extensor carpi radialis, extensor digitorum)
      2. Median Nerve (C7, C8, T1): Cannot make 'OK' Sign
         1. Opposition of thumb and index finger against resistance
      3. Ulnar Nerve (C8-T1): Claw Hand
         1. Finger abduction against resistance
   2. Lower extremity
      1. Femoral Nerve (L1-L4)
         1. Hip flexion against resistance (Iliopsoas muscle)
      2. Sciatic Nerve (L5-S2)
         1. Knee flexion against resistance (Hamstring muscles)
      3. Deep Peroneal Nerve (L4-L5): Foot drop
         1. Dorsiflexion against resistance (tibialis anterior muscle)
      4. Tibial Nerve (S1-S2)
         1. Plantar flexion against resistance (gastrocnemius muscle, soleus muscle)
5. Exam: Upper Extremity Strength
   1. 
   2. C3-5: Spontaneous Breathing ("C3-4-5 keeps the diaphragm alive")
   3. C3-4: Trapezius function
   4. C5: Shoulder External Rotation (Infraspinatus)
   5. C5: Deltoid and Supraspinatus abduction at Shoulder (Axillary Nerve)
   6. C5-6: Biceps Flexion at Forearm (Musculocutaneous Nerve)
   7. C6: Forearm Supination (Radial Nerve)
   8. C6-7: Forearm Pronation (Pronator Teres; Median Nerve)
   9. C6-7: Wrist Extension (extensor carpi radialis brevis and longus; Radial Nerve)
   10. C7: Wrist Flexion (flexor carpi radialis brevis and flexor carpi ulnaris; Median Nerve and Ulnar Nerve)
   11. C7: Elbow Extension (Triceps, Radial Nerve)
   12. C7-8: Finger Extension (Extensor digitorum, extensor indicis, extensor digiti minimi; Radial Nerve - posterior interosseous)
   13. C7-8: Thumb Abduction (Abductor Pollicis Longus; Radial Nerve - posterior interosseous)
   14. C8: Thumb Extension and Adduction
   15. C8: Wrist Extension and incline ulnar aspect of hand (Extensor Carpi Ulnaris)
   16. C8: Fingers Flexion middle finger (flex dig profundus, Median Nerve)
   17. C8-T1: Thumb Flexion (flexor pollicis longus, Median Nerve - anterior interosseous)
   18. T1: Small finger abductors (abductor digiti minimi)
   19. T1: Spread Fingers (Interosseus intrinsic Hand Muscles; Ulnar Nerve)
6. Exam: Lower Extremity Strength
   1. L2-3: Hip flexors (Iliopsoas)
   2. L3-4: Knee Extension (Quadriceps)
   3. L4: Ankle dorsiflexion (tibialis anterior)
   4. L4: Anterior Tibial - Foot Inversion
   5. L5: Great toe extension (Extensor hallucis longus)
   6. L5: Foot dorsiflexion (Extensor digitorum longus)
   7. L5: Weak heel walking, foot drop
   8. S1: Ankle plantar flexors (Gastrocnemius, Soleus)
   9. S1: Toe walking
   10. S1: Foot Eversion
   11. S2-4: Reflex Defecation Center ("S2-3-4 keeps the stool off the floor")