NMD

smell- tested in one nostril w/ eyes closed

lost sense of smell

distorted sens of smell

• vision- tested with snellen chart (acuity and visual fields)
• direct light reflex
• indirct light reflex
• accomodation

• ciliary
• constrictor papillae

deviation of one or both eyes

eyelids droop due to weakness or paralysis of levator palpebrae

superior oblique

• the face (V1-3)
• corneal reflex
• oculocardiac reflex
• sensation to anterior 2/3 of tongue

mm of mastication (V3)

trigeminal neuralgia, shock-like pain to the face lasting less than 2 minutes per episode. Excruciating pain is repetitive, occuring several times a day. pain is typically felt on one side of the jaw or cheek

lateral rectus

anterior 2/3 of tounge (sweet/salty/sour)

mm of facial expression

• Unilateral facial paralysis caused by trauma, immune or virus- not permanent
• pain behid ipsilateral ear, drooping of eyelid, drooling, dry eye, impairment of taste

vestibular balance: tested with mittlemeyer, barany caloric test, rombergs

• endolympatic hydrops
• cause is unknown, vertigo, hearing loss, tinnitus

• gag, uvula, and carotid reflex
• taste to posterior 1/3 of tongue (bitter tastes)

stylopharyngeus- elevate pharynx/larynx

epiglottis and laryngeal mm of swallowing

gag reflex, carotid reflex and uvular reflex

• trapezius & SCM mm
• torticollis aka wry neck

tonque mm- deviates to the side of lesion

involuntary motor responses to potentially harmful stimuli

done bilaterally with the NORMAL side tested first

absence of any DTR - especially patellar (LMNL)

Brings out reflexes by cortical distraction

• 0- absent w/ reinforcement
• 1- hypoactive w/ no reinforcement or w/ normal reinforcement
• 2= NORMAL
• 3- hyperactive
• 4-hyperactive w/ transient clonus
• 5- hyperactive w/ sustained clonus

• jaw jerk- trigeminal
• biceps- mskcutaneous
• brachioradialis- radial
• triceps- radial
• patella- femoral
• posterior tib- tibial
• medial ham- sciatic
• achilles- tibial

stroke inner thigh of male, ipsilateral rise in testes

stroke up inner female thigh, pouparts ligament contracts

stroke up sole of foot- curling of toes and pulling away of foot

pinch neck while noting dilation of the eyes- sesonry from neck- cerv. symathetics

press on the ye- note slowing of the hr by 10bpm

press on carotid note slowing of heart and decreased pressure

• Chaddock-stroke down lateral malleolus to 5th toe
• Oppenheim- stroke tibial crest to ankle
• Gordons- squeeze calf
• Schafer- squeeze achilles

tap the ball of the foot

• 5= normal
• 0= no evidence of contractility

• Drop Wrist- radial nerve
• Claw Hand- Ulnar nerve
• Median Nerve- Ape Hand

• Site-under flexor retinaculum
• Caused by trauma, obesity, fluid retension, pregnancy, hypothyroidism, RA
• Presents with nocturnal pain, paresthesi of hand, thenar atrophy, and weak opponens: ape hand
• Affects first 3 fingers
• TRMNT: adjust, cock up and splint, diuretic, B6

• site: between heads of pronator at elbow
• anterior interosseus nerve
• pain on volvar aspect of forearm, first 3 fingers
• trmnt: trigger point therapy, spray and stretch

• site: tunnel of guyon, or cubital tunnel
• caused by trauma/microtrauma
• presents w/ p and numbness in last 2 digets
• weakness of add pollicis
• trmnt: adjust tape and support

• aka: wrist drop, erbs palsy, waiters tip deformity, saturday night palsy, crutch palsy,
• site: spiral groove
• caused by trauma, lead poisoning or pressure
• presents w/ loss of triceps reflex, decreased sensation to post/lat 3.5 fingers

• scapular winging
• result of trauma, iatrogenic, idiopathic, paralysis of serratus ant.

• dorsal scapular nerve impingement
• injury to rhomboids

• meralgia paresthetica
• site: over the pubic brim under inguinal ligament.
• L2/3 nerve roots
• caused by: external pressure, obesity/tight jeans
• burning sensation on anterolateral thigh

• site: pelvis hip, popliteal fossa
• caused by: trauma, traction, piriformis, mm spasm
• presents: post butt, thigh, back of leg pain
• weak knee flex and decreased achilles reflex

• medial plantar nerve
• caused by posteror traumatic ankle deformity
• patient presents w/ burning paresthsia on sole of feet
• trmnt: adjust, orthotic support

• intermetatarsal neuroma
• site: between 3rd and 4th digit
• pain on toes and dorsum of foot
• test: mortons squeeze

• site: fibular head
• cause: trauma
• presents: pain on lateral aspect of leg, weak mm or foot drop
• trmnt: adjust

• anterior compartment syndrome
• affect any mm in the compartment
• s/s similar to charcot marie tooth

fingertip curled in- injury which damage or tore the tendon

hyper flexion of the DIP and hyperextension of the PIP

hyperextension of the DIP and hyperflexion of the PIP

abnormal thickening of the skin, causes last two fingers to curl into palm

finger becomes locked in bent position- sheath produces a popping or snapping sound

• aka: benediction/papal hand
• wasting of hypothenar eminence and flexion of 4th and 5th digits

claw-like deformity of the hand and all fingers

• inflammation of ext. poll. brev. and abd. poll. long tendons.
• trmnt: bracing of thumb and wrist
• test: finkelstein's test +

• 2 pt discrim, vibration and jt position
• related to MS, tabes dorsalis, leprosy

• pain and temperature
• related to syringomyelia

reflexes and postural mm

• long. cyst of the central canal of the SC- weakening around C5-C6
• loss of pain and temp over the shoulders and back: shawl and cape distribution!

• demyelination of CNS
• plaques present on MRI
• females 20-40
• worse when moving from Cold to warm climate
• Charcot's triad: scanning speech, intention tremors, nystagmus (SIN)

• autoimmune disease in which the body makes anitbodies against the AcH receptors. myoneural junction dysfunction. Weakness: proximal musles (eyes)
• early signs: diplopia, ptosis, dysarthria, fatigue of mm. Worse at end of day.
• females: 20-40 yo
• dx: with tensilon test
• treatment: cholinesterase inhibitor drugs

• begins int he hands/feet- short life expectancy
• fasiculation, spasticity and increased DTR
• lmnl in the arms
• umnl in the legs
• ddx with lat. canal stenosis

• degen of the post. columns and corticospinal tracts
• b12 def (pernicious anemia)
• (+) Shilling test
• Glove and Stocking Paresthesia

PLS

• partially severed SC
• ipsilateral loss of montor function and dorsal columns
• contralateral loss of pain and temp

• non-progressive motor disorder
• anoxia to brain prenatally or during birth
• SCISSOR GAIT
• spastic paraysis (umnl)
• choreiform movements

• chronic progressive condition
• loss of dopamine in subst. nigra
• basal gang dysfnx
• resting tremor, mask-like face, festinating gait, cogwheel/lead pipe rigidity

• associated to recent immunization
• inflammatory polyneuropathy
• seen after illness
• starts in hands and works up

• clinical cond. of tertiary syphillis
• wasting away of posterior columns
• prostitutes pupil: accomodates but does not respond
• slappage gait

• sex link recessive
• boys 3-7
• waddling gait
• gower's sign= roll onto all 4s to help themselves up
• increased CPK, decreased creatinine (in urine)

• hereditary disease
• weakness of foot and lower leg
• foot drop- hight step gait
• frequent tripping
• lower leg atrophy

mental deterioration, amnesia, depression, anxiety rigidity

• neurodegenerative genetic disorder
• affects mm coordination
• cognitive decline
• dementia

• rectus femoris
• unstable knee gait

quads, glues, unstable knee/lurching gait

• foot dorsiflexor
• slappage gait

• gastroc/soleus
• flat foot

• initial- toe off through knee flex/quads
• mid- max knee flex through tibia perpendicular to ground, ankle dorsiflexors, steppage gait
• terminal- tibia through heel strike, hamstrings

parkinsons, small shuffling steps

cerebral palsy, knee crosses body when walking

muscular dystrophy

anterior comp. syndrome, foot drop, l4 lesion, paralysis of ant. tibia

weak glute med, lurching and drastic pelvic tilt

posterior column diseases, sensory ataxia

stroke, swing-unilateral-spastic hemiplegia

UMNL

avoid provoking pain

wide based gait- cerebellar

occ and C1

c1/C2

• tinlging into 4/5th digits
• - adsons:scalene anticus
• - modified adsons: scalene medius
• -costoclavicular, edens: 1st rib and clavicle
• - wrights, hyperabduction: pec minor and axillary nerve
• - halsteads: cervical rib

supraspinatus

• - Supraspinatus: AB
• - Infraspinatus: EX
• - teres minor: EX
• - Subscap: IN

• aka: radio-humeral bursitis, tennis elbow
• affects: extensor carpi radialis brevis!

• aka: little leagures elbow, golfers elbow
• affects:flexor carpi ulnaris
• treatment: transverse massage, ultrasound underwater, counterforce brace

• vitamin B6 (natural diuretic)
• cock-up splint
• adjust lunate

scaphoid

rectus femoris contracture

hip lesion, iliopsoas irritation or inflammed lumbar NR

vastus medialis

• aka: unhappy triad
• mcl, acl, medial meniscus

fractured patella

osteochondritis dissicans

• flat foot- talar head displaced medially
• exercise/orthotics

• MC birth defect/ heel elevated and foot turned inward
• AKA: Club Foot

• high arch- toes in flexion
• orthotics stretch out
• prone to march fractures

tumor on the nerve MC between 3 and 4th metatarsal heads

march frx

heel spur pain when walking in the morning. improves throughout the day.

pain and burning on sole of foot (medial plantar nerve)

+ thompsons test aka Simmond's trauma

• 1) no ligamentous tear. slight swelling and decreased ROM.
• 2) incomplete/partial rupture. lots of swelling, bruising, almost no ROM.
• 3) complete tear. surgical case. *REFER* to orthopedist

patient presents w/ fever, HA, photophobia, and nuchal rigidity

• increase in protein indicates VIRAL
• decrease in glucose indicates BACTERIAL

the pat spont. grasps head with both hands when rising from the recumbent position. indicates cervical instability due to sprina/strain, frx, RA

normal hearing

sound lateralizes to the good/uninvolved ear

sensorneural loss on L or Conductive hearing loss on R

cluster

hypertension HA

subarchnoid HA

decreased breath sounds, hyperresonant sounds

decreased

pneumonia

vesicular

hemolytic