Sunday, November 2, 2008
The hamstring reflex
Since the knee jerk is L4 and the ankle jerk S1, the L5 root is usually omitted from exam. The biceps (of the hamstring) and semitendinosis reflexes are tested, both high sciatic reflexes. Biceps is primarily L5 and is lateral, semitendinosis is L4 and medial.
Crossed adductor measures at L2
More DTR pearls:
1. Prolonged reflex is not just with hypothyroid, but also cerebellar disease, (pendular oscillating), protein malnutrition (change in elastic quality of tendons), hyponatremia and syphilis.
CRPS I and II
Five components of:
1. Pain, especially mechanical and thermal allodynia, hyperalgesia and hyperpathia
2. neurogenic edema
3. autonomic dysregulation with abnormal circulation, livedo reticularis and hyperhidrosis
4. Movement disorder with inability to initiate or maintain maovements, dystonia, weakness, spasms and tremor
5. atrophy and dystrophy.
In type I there is no identifiable nerve injury, in type 2 there is. Its regional, non nerve dependent and spreads, initially is sympathetic dependent later not.
Brachial plexitis examination pearls sensation
Sensory loss
1. The lateral cord encompasses the thumb and index finger and splits the middle finger
2. The medial cord splits the third finger to the unlar side and encompasses the ring and pinky fingers and medial forearm.
3. The lower trunk innervates the fourth and fifth fingers and continues up the forearm
4. The ulnar nerve innervates only a small triangular region across the wrist, as well as the ulnar distributed area on the hand.
5. Schwartzman describes additional techniques for the exam of plexus: The Roos abduction maneuver== holding hands up to imitate a goal post elicits numbness after 30 seconds
6. The Wright maneuver-- holding hands straight up, does same
7. The plexus can be palpated at various points: in the supraclavicular fossa (upper trunk); between the clavicle and the first rib; the neurovascular bundle against the medial humerus; at the elbow in the arcade of Frohse (entry of radial sensory and posterior interosseous nerves);
8. The intercosticobrachial nerve, from the medial cord, innervates the anterior chest and can be misdiagnosed as cardiac disease. acid reflux, gall bladder disease (if on the right) or costochondritis.
Pain
1. Upper trunk pain (C5-6 roots) radiates across trapezius ridge and down medial scapula, whereas radiculopathic pain from c6-7 GOES DOWN SPINE. Upper trunk is palpable in supraclavicular fossa, and radiation to tip of scapula (notalgia) is usually painful.
2. Middle trunk persterior cord plexus radiations are on dorsal arm across triceps, enters the forearm through the arcade of Frohse (medial to the lateral epicondyle) to innervate the forearm, and extensor surface of the thumb, index and third fingers.
3.
1. The lateral cord encompasses the thumb and index finger and splits the middle finger
2. The medial cord splits the third finger to the unlar side and encompasses the ring and pinky fingers and medial forearm.
3. The lower trunk innervates the fourth and fifth fingers and continues up the forearm
4. The ulnar nerve innervates only a small triangular region across the wrist, as well as the ulnar distributed area on the hand.
5. Schwartzman describes additional techniques for the exam of plexus: The Roos abduction maneuver== holding hands up to imitate a goal post elicits numbness after 30 seconds
6. The Wright maneuver-- holding hands straight up, does same
7. The plexus can be palpated at various points: in the supraclavicular fossa (upper trunk); between the clavicle and the first rib; the neurovascular bundle against the medial humerus; at the elbow in the arcade of Frohse (entry of radial sensory and posterior interosseous nerves);
8. The intercosticobrachial nerve, from the medial cord, innervates the anterior chest and can be misdiagnosed as cardiac disease. acid reflux, gall bladder disease (if on the right) or costochondritis.
Pain
1. Upper trunk pain (C5-6 roots) radiates across trapezius ridge and down medial scapula, whereas radiculopathic pain from c6-7 GOES DOWN SPINE. Upper trunk is palpable in supraclavicular fossa, and radiation to tip of scapula (notalgia) is usually painful.
2. Middle trunk persterior cord plexus radiations are on dorsal arm across triceps, enters the forearm through the arcade of Frohse (medial to the lateral epicondyle) to innervate the forearm, and extensor surface of the thumb, index and third fingers.
3.
Subscribe to:
Posts (Atom)