Neurology Book


Motor Exam

Aka: Motor Exam, Strength Grading, Muscle Strength, Myotome, 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. brachialPlexus.jpg
    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 Muscle, femoral nerve)
    2. L3-4: Knee Extension (Quadriceps Muscles, femoral nerve)
    3. L4: Ankle dorsiflexion (tibialis anterior Muscle, deep peroneal nerve)
    4. L4: Anterior Tibial - Foot Inversion
    5. L5: Hip Extension (inferior gluteal nerve)
    6. L5: Great toe extension (Extensor hallucis longus Muscle)
    7. L5: Foot dorsiflexion (Extensor digitorum longus Muscle)
    8. L5: Weak Heel Walking, Foot Drop
    9. S1: Knee Flexion (sciatic nerve)
    10. S1: Ankle plantar flexors (Gastrocnemius and Soleus Muscles, tibial nerve)
    11. S1: Toe Walking
    12. S1: Foot Eversion
    13. S2-4: Reflex Defecation Center ("S2-3-4 keeps the stool off the floor")

Structure of myotome (C0231043)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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
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
Derived from the NIH UMLS (Unified Medical Language System)

Motor root (C2339332)

Concepts Classification (T185)
English Motor root
Derived from the NIH UMLS (Unified Medical Language System)

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