Ebook Atlas of adult physical diagnosis: Part 2
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Ebook Atlas of adult physical diagnosis: Part 2
Neurologic ExaminationPRACTICE AND TEACHINGOVERALL EXAMINATIONOverall neurologic examination includes the thorough assessment of power, tone, reflexes Ebook Atlas of adult physical diagnosis: Part 2s, cranial nerves, and function of the sensory structures.Power AssessmentThe neurologic examination includes the assessment of the power, also known as strength of various muscle groups. Two muscle groups from the proximal upper and lower extremities should be examined. Shoulder elevation or shrugg Ebook Atlas of adult physical diagnosis: Part 2ing against resistance is assessed for proximal muscle strength, trapezius muscle function, and cranial nerve (CN) XI function (Fig. 7.1). For this asEbook Atlas of adult physical diagnosis: Part 2
sessment, the patient actively elevates the shoulders, i.e., shrugs, while the examiner applies resistance; feel the trapezius muscle. Arm extension INeurologic ExaminationPRACTICE AND TEACHINGOVERALL EXAMINATIONOverall neurologic examination includes the thorough assessment of power, tone, reflexes Ebook Atlas of adult physical diagnosis: Part 2orearm dangling down at the elbow: the patient then actively extends the forearm at theFigure 7.1.Technique for power assessment of proximal upper extremities: elevation of shoulders.Figure 7.2.Technique for power assessment of triceps and proximal arm: extension of elbows.T TIPS■With patient's arm Ebook Atlas of adult physical diagnosis: Part 2abducted to90 degrees, forearm dangling at the side, actively extended at elbow: apply resistance to the distal forearm■Triceps muscle contraction■RadEbook Atlas of adult physical diagnosis: Part 2
ial nerve or root of C7 problem: unilateral paresis, fascicutations. and even atrophy of the triceps muscle■Proximal muscle weakness: bilateral paresiNeurologic ExaminationPRACTICE AND TEACHINGOVERALL EXAMINATIONOverall neurologic examination includes the thorough assessment of power, tone, reflexes Ebook Atlas of adult physical diagnosis: Part 2ess161Chaptar 7162Figure 7.3.Technique for power assessment of proximal hip A. Forward flexion of hip with patient standing B. Patient supine.T TIPS■Patient standing (A), or Supine (Bl. or sitting (see Hip Examination chapter}■Start from about 10 to 20 degrees, leg supported by the examiner at this Ebook Atlas of adult physical diagnosis: Part 2baseline, apply resistance on the distal anterior thigh■Iliopsoas muscle damage or nerve roots L2 and 3: unilateral paresis■Proximal muscle problem: bEbook Atlas of adult physical diagnosis: Part 2
ilateral pares tsBelbow against resistance applied by the examiner; feel the triceps muscle. Hip forward flexion is assessed for proximal muscle strenNeurologic ExaminationPRACTICE AND TEACHINGOVERALL EXAMINATIONOverall neurologic examination includes the thorough assessment of power, tone, reflexes Ebook Atlas of adult physical diagnosis: Part 2tting. The standing position (Fig. 7.3A) or with the patient supine with leg suppported by examiner at 10 degrees of forward flexion (Fig. 7.3B) or, sitting with knees flexed are all acceptable. The patient then actively forward flexes the leg while the examiner applies resistance to the distal ante Ebook Atlas of adult physical diagnosis: Part 2rior thigh. From the seated position, the patient Is instructed to raise the knee straight upward. Hip backward flexion is assessed for proximal musclEbook Atlas of adult physical diagnosis: Part 2
e strength, gluteal muscle function, and lower lumbar and upper sacral root function (1.4.5 and SI. 2) (Fig. 7.4). Assessment is with the patient eithNeurologic ExaminationPRACTICE AND TEACHINGOVERALL EXAMINATIONOverall neurologic examination includes the thorough assessment of power, tone, reflexes Ebook Atlas of adult physical diagnosis: Part 2 of the table (Fig. 7.4B). The patient actively backward flexes the leg against resistance applied to the posterior distal thigh. Extension at knee is assessed for proximal muscle weakness, midlumbar root function (L3. 4). femoral nerve and quadriceps muscle function (Fig. 7.5). Assessment is one in Ebook Atlas of adult physical diagnosis: Part 2 which the patient Is either supine or sitting with knees flexed and supported in 40 degrees of flexion. The patient actively extends the leg at the kEbook Atlas of adult physical diagnosis: Part 2
nee while the examiner applies resistance at the middlstal anterior leg.The grading of power uses the classic 5 to 0 numerical system. In this system,Neurologic ExaminationPRACTICE AND TEACHINGOVERALL EXAMINATIONOverall neurologic examination includes the thorough assessment of power, tone, reflexes Ebook Atlas of adult physical diagnosis: Part 2is of greatest diagnostic use. See Table 7.2 for specific details. The various patternsFigure 7.4.Technique for power assessment of proximal hip A. Backward flexion of hip. patient standing. B. Patient prone.▼ ' TIPS Ebook Atlas of adult physical diagnosis: Part 2Neurologic ExaminationPRACTICE AND TEACHINGOVERALL EXAMINATIONOverall neurologic examination includes the thorough assessment of power, tone, reflexesGọi ngay
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