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09.April.2014 Wednesday
History
Cerebral function (mental status)
Cranial nerve function
Motor function
Sensory function
Cerebellar function
Reflex function
Gait and stance
Neurologic Exam
Susan R. Winkler, Pharm.D. BCPS
Spring 1998
Deltoid
The arm is abducted, starting from
approximately 15°, against resistance. If
acting normally, the deltoid can easily be
seen and palpated.
Shoulder abduction
Axillary nerve
Supraspinatus
Initiates abduction of the arm
Suprascapular nerve
Abduction of the arm from
fully adducted position against
resistance.
Palpated superior to scapular spine.
Supraspinatus & middle deltoid tested together.
Infraspinatus
The person flexes the elbow and
adducts the arm. The arm then
laterally rotated against
resistance.
Infraspinatus & teres minor tested together.
Palpated inferior to scapular
spine.
Laterally rotates the humerus
Suprascapular nerve
Degenerative tendonitis of the rotator cuff
The person is asked to lower the fully abducted limb slowly and
smoothly.
From approximately 90° abduction, the limb will suddenly drop to the
side in an uncontrolled manner if the rotator cuff (especially
supraspinatus part) is diseased and/or torn
Biceps brachii
Forearm flexor & supinator
Musculocutaneous nerve
Elbow joint is flexed against resistance when the forearm is
supinated. If acting normally, the muscle forms a prominent bulge
on the anterior aspect of the arm that is easily palpated.
Main flexor of the forearm
Musculocutaneous nerve
Brachialis
Forearm is semipronated and flexed against resistance.
If acting normally, the contracted muscle can be seen and palpated.
Forearm extension
Radial nerve
Triceps brachii
The arm is abducted 90° and then the flexed forearm is extended
against resistance provided by the examiner.
If acting normally, the triceps can be seen and palpated.
Flexor carpi ulnaris
Flexor & adductor of the wrist
Ulnar nerve
The person puts the posterior aspect of the forearm and hand on a flat
table and is then asked to flex the wrist against resistance while the
examiner palpates the muscle and its tendon.
Flexor carpi radialis
Flexor & abductor of the wrist
Radial nerve
The person is asked to flex the wrist against resistance. If acting
normally, its tendon can be easily seen and palpated.
Palmaris longus
Accessory flexor of the wrist, opposes
shearing forces on the skin of the palm
during gripping
Median nerve
The wrist is flexed and the pads of the little finger and thumb are
tightly pinched together.
If present and acting normally, the tendon can be easily seen and
palpated.
Rotates radius over ulna during pronation
Median nerve
Pronator teres
The person's forearm is flexed at the elbow and pronated from
the supine position against resistance provided by the
examiner.
If acting normally, the muscle is prominent and can be palpated
at the medial margin of the cubital fossa.
Flexor digitorum superficialis
Flexes the
metacarpophalangeal joint
and proximal interphalangeal
joint of each finger; also
flexes the wrist joint.
Median nerve
One finger is flexed at the proximal interphalangeal joint
against resistance and the other three fingers are held in
an extended position to inactivate the flexor digitorum
profundus.
Flexor digitorum profundus
Flexes the distal phalanges of
the medial four fingers
Lateral half median nerve
Medial half ulnar nerve
The proximal interphalangeal joint is held in the extended
position while the person attempts to flex the distal
interphalangeal joint.
The integrity of the median nerve in the proximal forearm can be
tested by performing this test using the index finger, and that of
the ulnar nerve can be assessed by using the little finger.
Flexes the thumb
Median nerve
Flexor pollicis longus
The proximal phalanx of the thumb is held and the distal
phalanx is flexed against resistance.
Brachioradialis
Relatively weak flexion of
forearm; maximal when forearm
is in midpronated position
Radial nerve
Elbow joint is flexed against resistance with the forearm in the
midprone position.
If the brachioradialis is acting normally, the muscle can be seen
and palpated.
Extend & abduct hand @ wrist
Radial nerve
Extensor carpi radialis longus
Wrist is extended & abducted with forearm pronated.
Its tendon can be palpated proximal to the wrist.
Extensor digitorum
Extends medial four digits primarily
@ metacarpophalangeal joints,
secondarily @ interphalangeal joints
Posterior interosseous nerve
Forearm is pronated and the fingers are extended.
The person attempts to keep the digits extended @
metacarpophalangeal joints as the examiner exerts pressure on the
proximal phalanges by attempting to flex them.
Tendons on the dorsum of the hand
Extensor carpi ulnaris
Extends and adducts hand @ wrist
Posterior interosseous nerve
Forearm pronated & fingers are extended
Extended wrist is then adducted against resistance.
Muscle seen and palpated
proximal part of the forearm & tendon felt proximal to ulnar head
Extensor digiti minimi
Extends 5th digit primarily
@metacarpophalangeal joint,
secondarily @ interphalangeal joint
Posterior interosseous nerve
Little finger is extended against resistance
while holding digits 2-4 flexed @ metacarpophalangeal joints
Abductor pollicis longus
Abducts thumb and extends
it @ carpometacarpal joint
Posterior interosseous nerve
Thumb is abducted against resistance at the metacarpophalangeal
joint.
Tendon seen and palpated at the lateral side of the anatomical snuff
box and on the lateral side of the adjacent extensor pollicis brevis
tendon.
Extensor pollicis brevis
Thumb is extended against
resistance at the
metacarpophalangeal joint.
Tendon @ lateral side of the
anatomical snuff box and on the
medial side of the adjacent
abductor pollicis longus tendon
Extends proximal phalanx of thumb
@ metacarpophalangeal joint;
extends carpometacarpal joint
Posterior interosseous nerve
Extensor pollicis longus
Thumb is extended against
resistance at the
interphalangeal joint.
Tendon on the medial side of
the anatomical snuff box
Extends distal phalanx of thumb @
interphalangeal joint; extends
metacarpophalangeal &
carpometacarpal joints
Posterior interosseous nerve
Abductor pollicis brevis
Abducts the thumb, principally
@ metacarpophalangeal joint
Median nerve
Abduct the thumb against resistance
Flexor pollicis brevis
Flex the thumb against resistance
Flexes metacarpophalangeal
joint of the thumb
Median nerve
Lumbricals
With the palm facing
superiorly patient is asked to
flex the metacarpophalangeal
(MP) joints while keeping the
interphalangeal joints
extended.
The examiner uses one finger
to apply resistance along the
palmar surface of the proximal
phalanx of digits 2-5
individually.
Participate in flexing
metacarpophalangeal joints &
extending the interphalangeal joints
Medial 2 ulnar nerve
Lateral 2 median nerve
Dorsal interossei
Examiner holds adjacent
extended and adducted fingers
between thumb and middle
finger,
Providing resistance as the
individual attempts to abduct
the fingers
(the person is asked to “spread
the fingers apart”).
Major abductors of the index,
middle, and ring fingers @
metacarpophalangeal joints
Ulnar nerve
Palmar interossei
Addduct thumb, index, ring, and little
fingers @ metacarpophalangeal joints
Ulnar nerve
A sheet of paper is placed between
adjacent fingers.
The individual is asked to “keep the
fingers together” to prevent the
paper from being pulled away by
the examiner.
Trapezius
The shoulder is shrugged against
resistance (the person attempts to
raise the shoulders as the examiner
presses down on them).
If the muscle is acting normally, the
superior border of the muscle can be
easily seen and palpated.
Superior fibers elevate scapula
Middle fibers retract scapula
Inferior fibers depress scapula
and lower the shoulder.
The superior and inferior fibers work
together to rotate the lateral aspect of
the scapula upward, which needs to
occur when raising the upper limb
above the head.
Spìnal accessory nerve (CN XI)
Latissimus dorsi
Adductor of the humerus
Extension, adduction, and
medial rotation of the upper
limb.
Depresses the shoulder,
preventing its upward
movement.
Thoracodorsal nerve
The arm is abducted 90° and then
adducted against resistance
provided by the examiner.
If the muscle is normal, the
anterior border of the muscle can
be seen and easily palpated in the
posterior axillary fold.
Rhomboids
Individual places the hands posteriorly
on the hips and pushes the elbows
posteriorly against resistance provided
by the examiner.
Palpated along the medial borders of
the scapulae; because they lie deep to
the trapezius, they are unlikely to be
visible during testing.
Retract and rotate the
scapula, depressing its
glenoid cavity. Assist the
serratus anterior in holding
the scapula against the
thoracic wall.
Dorsal scapular nerve
Pectoralis major
Adduction and medial rotation of the arm
Clavicular head flexes humerus
Sternocostal head extends it back
Lateral and medial pectoral nerves
clavicular head (C5, C6), sternocostal head (C7, C8, T1)
Clavicular head
The arm is abducted 90°; the individual
then moves the arm anteriorly against
resistance.
If acting normally, the clavicular head can
be seen and palpated.
Sternocostal head
The arm is abducted 60° and then
adducted against resistance. If acting
normally, the sternocostal head can be
seen and palpated.
Serratus anterior
The hand of the
outstretched limb is
pushed against a wall.
If the muscle is acting
normally, several
digitations of the
muscle can be seen and
palpated.
Protracts scapula and holds it against
thoracic wall; rotates scapula
Long thoracic nerve
Inferior lateral
cutaneous nerve of arm
Lateral & anterior
aspects of the lower
part of the arm
Medial cutaneous
nerve of forearm
Medial surface of the
forearm down to the
wrist
Posterior cutaneous
nerve of forearm
Posterior aspect of the
arm and forearm
Medial cutaneous
nerve of arm
Medial side of the
distal third of the arm
Lateral
cutaneous
nerve of
forearm
Lateral half of
the anterior
aspect forearm
supraclavicular nerves
(medial,intermediate,lateral) the skin as
far as the middle line, the skin over the
pectoralis major and deltoideus, the skin of
the upper and posterior parts of the
shoulder,
inferior part of the deltoid muscle
Superficial branch of the radial nerve
Dorsolateral aspect of the palm
Dorsal aspects of the lateral 3 ½ digits
distally to approximately the terminal
interphalangeal joints
Ulnar nerve
Medial 1/3 of the palm
Medial half of the dorsum of the hand
5th finger & medial half of the 4th
finger
Anterior surfaces of the medial 1 ½
digits
Median nerve
Thumb,index,middle fingers
Lateral side of the ring [distal parts on the
dorsum of the hand]
Palmar surface of the lateral 3 ½ digits
Lateral (2/3) side of the palm & middle of
the wrist
The dermatomes for the upper cervical
segments C3 to 6 are located along the
lateral margin of the upper limb
C7 dermatome is situated on the middle
finger
C8, T1, and T2 along the medial margin of
the limb
Biceps brachii tendon reflex C5 & 6
flexion of the elbow joint by tapping the biceps tendon
Triceps tendon reflex C6, 7, and 8
extension of the elbow joint by tapping the triceps tendon
Brachioradialis tendon reflex: C5, 6, and 7
supination of the radioulnar joints by tapping the
insertion of the brachioradialis tendon
NEUROLOGICAL EXAM
Online resources
NeuroLogic Examination Videos and Descriptions...an Anatomical
Approach
The Precise Neurological Exam
Neuroexam
Neurologic Examination
The Neurological Examination
What is a Neurological Exam?
The Neurological Examination
Neurologic Exam