Muscles of lower limb
Muscles of lower limb
(1) Intrinsic muscles of foot: cannot be easily tested. In paralysis of interossei ‘claw foot’ may develop. (2) Flexors and extensors of toes and foot: Dorsiflexion and extension are tested against resistance (3) Extensors of knee: Bend the patient’s knee and then pressing with the examiner’s hand on the shin, ask him to straighten it.
(4) Flexors of the knee: The patient’s leg is raised up from the bed by supporting the thigh with the left hand and ankle with the right hand. Ask the patienf to bend the knee.
(5) Extensors of the thigh: With the knee extended, try to lift the patient’s foot off the bed. The patient is asked to resist the limb elevation.
(6) Flexors of thigh: With the leg extended, ask the patient to raise his leg off the bed against resistance (7) Adductors of thigh: Abduct the lower limb and ask the patient to bring it back to the midline against resistance. (8) Abductors of thigh: Place the patient’s legs together and ask him to separate them against resistance. (9) Rotators of thigh - With the lower limbs extended on the bed, ask the patient to roll it outwards or inwards against resistance.
a) Hemiplegia: Paralysis of one side of the body (especially of the arm, leg and face)
b) Crossed hemiplegia: Here there is paralysis of the muscles of the arm and leg on one side, and the
region supplied by the motor cranial nerves of the other side.
c) Paraplegia: Paralysis of both legs.
d) Monoplegia: Paralysis of one limb.
1. Brachial monoplegia. [paralysis of one upper limb]
2. Caudal monoplegia [paralysis of one lower limb] e) Quardriplegia: All four limbs are paralysed.
IV Co-ordination of movements:
Co-ordination refers to the recruitment, interaction and co-operation of separate groups of muscles in order to accomplish a definite motor act. If co-ordination is affected, the motor performance becomes difficult and ataxia occurs. Various factors like cerebellar function, muscle tone, and impulse production from muscle spindles influence co-ordination.
(1) For upper limb
a) Finger nose test: The person is asked to fully extend and abduct the arm, and then touch the tip of his nose with the index finger. The test is repeated with the eyes closed.
Abnormalities - In cerebellar disease, the finger moves to the nose in a wavering manner. In sensory ataxia (eg. tabes dorsalis) the movement is smooth with the eyes open, but when eyes are closed the finger hesitates before touching the nose.
b) Finger to finger test: The person is asked to extend his arms to the side and then bring the tips of the index fingers together through a forward arc.
c) Dysdiadochokinesia: Normally a person can supinate and pronate the flexed forearm rapidly. In cerebellar ataxia there is impaired ability to rapidly execute such repeated movements. This sign is called Dysdiadochokinesia.
(2) For lower limb
a) Straight line test: Ask the patient to walk on a straight line. If co-ordination is absent, he will soon deviate to one side or the other.
b) Heel-knee test: If the person is unable to walk, the heel knee test is done. Ask him, as he lies in bed to lift one leg and place the heel of his leg on the opposite knee. Then slide the heel down the shin of the tibia towards the ankle. In cerebellar disease, the heel is carried to overshoot the knee. As the heel is carried downwards, it begins to execute a tremor like movement.
(3) Romberg’s test: The person stands with his feet close together and eyes open. After he has assumed a stable position he is asked to close his eyes. When the test is positive the person begins to sway and may even fall. Positive Romberg’s sign is seen in conditions with loss of position sense in the lower limbs (sensory ataxia) - tabes dorsalis, subacute combined degeneration, sensory polyeuropathies.
With the legs fully exposed, the person is asked to walk away from the examiner then to turn round at a given point, and to walk back to the examiner.
1) Spastic gait - seen in corticospinal lesions
2) Stamping gait - seen in tabes dorsalis
3) Drunken or Reeling gait - in cerebellar lesions
4) Festinant gait - seen in Parkinson’s disease
5) Waddling gait - seen in myopathies and muscular dystrophies
6) High stepping gait - seen in common peroneal nerve palsy
VI. Test the motor cranial nerves.
VII. Involuntary movements:
Involuntary unintended movements occur at rest or during voluntary movements in a number of nervous system diseases. eg. are,
(1) In epilepsy complex repetitive movements occur. In focal epilepsy the involuntary movements are limited to one limb.
(2) Tremor - regular or irregular distal movements having an oscillatory character are seen in thyrotoxicosis, Parkinson’s disease, cerebellar disease,
(3) Chorea - Huntington’s chorea is a familial disorder. Sydenham’s chorea is associated with rheumatic fever.
(4) Athetosis - seen in basal ganglia lesions
(6) Metabolic flaps are regular, abrupt movements seen in the outstretched hand and tongue. This may be seen in hepatic failure, uremia and respiratory fai!ure.
The corticospinal system initiates voluntary and skilled actions especially fine distal movements. The extrapyramidal system is concerned with initiation of movement and control of posture. It includes the basal ganglia, subthalamic nuclei, substantia nigra and red nuclei. The cerebellum maintains muscle tone and coordination of movements. The lower motor neuron is the final common pathway for muscular movements. Lower motor neuron lesions result in weakness, fasciculations, wasting. Loss of tendon reflexes and hypotonia. The skeletal muscle is the principal effector organ.
(1)Draw the pyramidal tracts.
(2) Differences between UMN & LMN type lesions in a tabular form.
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