Beruflich Dokumente
Kultur Dokumente
Motor System
In association with
Dr David Smith
Consultant Neurologist
Walton Centre for Neurology
and Neurosurgery
10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 1
Note
This study guide is designed with
right-handed examiners in mind.
please substitute appropriately if left-
handed
Arrows on photographs depict the
direction of movement of the limb
Limb Power
Reflexes
Abduction
C5/6 Adduction
C6/7/8
Flexion
Extension C5/6
C7/8
Flexion
Extension C6/7
C7/8
Flexion
Adduction Extension C7/8
C8/T1 C7/8
“Stop me trying to
bend your fingers
down”
Abduction Adduction
L4/5/S1 L2/3/4 Flexion
Extension L2/3
L5/S1/2
Flexion
Extension
L5/S1
L3/4
Dorsiflexion
Eversion Inversion L4
L5/S1 L5/S1 Plantar flexion
S1/S2
10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 22
Hip flexion (L2/3) and extension (L5/S1/2)
Position the patient with the leg
elevated to approx 30°
“Stop me
Attempt to overcome by
pushing your
leg down” pressing down on thigh
Position patient with leg flat on
“Stop me couch
trying to raise
your leg up” Place your hand underneath
thigh and attempt to elevate
leg while patient presses
down
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Knee flexion (L5/S1)
LMN lesion
involvement of nerve endings (peripheral
neuropathy) produces a predominantly distal
pattern of weakness
10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 27
Testing the
reflexes
10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 28
Reflexes
Normal reflex arc requires :-
Stimulus to stretch receptors
Contractile element
Absent -
Normal + or ++
Brisk +++
Biceps (C5/6)
Triceps (C7/8)
Supinator
(C5/6)
Abdominal
Ankle (S1/2)
Plantar (L5/S1/2)
10/13/2011 © Clinical Skills Resource Centre, University of Liverpool, UK 31
Testing for reflexes
Position the limb correctly
Hold the tendon hammer like a hammer
Place your finger over the tendon and strike it,
for some reflexes you will strike the tendon itself (see
slides below)
(except the ankle – see slide 38)
Observe the relevant muscle for contraction
(not the limb movement)
Be aware of the range of normality.
Abnormal reflexes rarely seen without other relevant
10/13/2011 signs © Clinical Skills Resource Centre, University of Liverpool, UK 32
Reinforcement
Where a reflex appears difficult
to elicit, reinforcement might
be tried.
Ask the patient to close their
eyes:
lower limb
ask the patient to grasp the
fingers of each hand and to
pull apart on instruction just as
the reflex is tested
Reinforcement for a lower limb
reflex – with patient’s eyes upper limb
closed the teeth may be clenched
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The upper limb
Reflex Testing