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The Neurological Examination
Dante P. Bornales, MD, MHPEd
Fellow of the Philippine Neurological Association
Part II Motor System Examination and Coordination
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The Neurological Examination
Always include the following in the
Motor System examination:
General Inspection of the Motor System
Muscle tone
Muscle Strength Manual Muscle Testing
Coordination
Your task: recall UMN and LMN lesions and signs
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Inspection
When inspecting, look for:
6. Wasting/Atrophy
- a reduction of the muscle bulk in certain muscles compared with
other muscle groups
- wasted muscles are frequently weak
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Observe!
muscle atrophy
of the thenar muscle
of the left hand
Always compare the
symmetry of muscles!
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Inspection
When inspecting, look for:
2. Body position/s
3. Scars
- may indicate previous injury/ies or surgery, which may have affected
a nerve or the muscle itself
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Inspection
When inspecting, look for:
4. Fasciculations
- seen as rippling or twitching of muscles at rest
5. Involuntary movements
- look for jerks, tremors, dystonia, other dyskinesias
- describe the abnormal movements
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Whenever possible,
always check for the patients gait
1. ask the patient to walk in his usual fashion, with arms on the
side
2. observe for patients posture, the pattern of the arm andleg movements, and the control of the trunk
3. if normal, ask:
heel-toe walk
stand on his toes and heels without support
hop! (most patients with significant weaknesscannot hop)
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Muscle Tone
Tone how floppy or stiff a limb feels
Some patients may have difficulty relaxing during the exam, which
can artificially increase stiffness in their limbs. Always do your
utmost effort to put them at ease!
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Testing for muscle tone
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Testing for muscle strength
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Full strength (cannot overcome the
movement)
5
Moves against resistance but not to full
strength
4
Moves against gravity but not against
resistance
3
Moves, gravity eliminated2
Flicker of muscle when pt. tries to move1
No movement0
MRC Scale for grading muscle strength
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Testing for shoulder adduction and abduction
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Testing for flexion (C5-C6 biceps) and extension ((C6-8)
at the elbow
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Testing for extension at the wrist (C6-8, radial nerve)
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Testing for extension and flexion at the wrist
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Testing for hand grip (C7-8, T1)
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Testing for finger abduction (C8-T1, ulnar nerve)
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Testing for opposition of the thumb ( C8, T1, median nerve)
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Testing for flexion at the hip L2-4, iliopsoas)
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Testing for extension at the hips (S1, gluteus maximus)
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Testing for adduction (L2-4, adductors) and abduction (L4-5, S1,
Gluteus maximus and medius) at the hips
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Testing for flexion at the knee (L4-5, S1-2, hamstrings
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Always remember to compare the symmetry of both sides
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Testing for extension at the knee (L2-4, quadriceps)
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Variation (sitting) in testing
for the hip flexion
Variation (sitting) in testing
for knee extension
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Variation in the position totest for knee flexion
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Testing for dorsiflexion (L4-5) and plantar flexion (S1)
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End of segment