An orthopaedic overview

Higher function Gait Cranial nerves Motor

◦ UMN and LMN◦ Reflexes

Sensory (vibration, proprioception, light touch, pinprick, TPD, temperature)

Autonomic (pupils, pulse, BP, bladder)

When would you test for higher function?

A. After a spinal cord injuryB. After a concussion

Spastic/scissors: CP or MS

Propulsive: Parkinsons

Steppage: foot drop

Waddling gait or Trendelenberg: weak proximal muscles

Twelve cranial nerves Deficits can be motor, sensory or autonomic Pupillary response part of examination of a

unconscious patient

Five patterns of muscular weakness:◦ UMN – tone, reflexes, pyramidal◦ LMN – tone, absent reflexes, wasting,

fasciculations◦ Muscle disease – wasting, impaired reflexes◦ NMJ – fatiguable weakness◦ Functional – erratic power

Root Movements Reflex

C5 Shoulder abd, elbow flex Biceps

C6 Elbow flex (semi-pronated) Supinator

C7 Finger ext, elbow ext Triceps

C8 Finger flexors Finger

T1 Intrinsic hand None

A. Ulnar, radial and median

B. Median, obturator and radial

Also

Musculo-cutaneous, Axillary, Long thoracic, Suprascapular and Rhomboid

Elbow extension Wrist extension Finger extension (posterior interosseous

nerve)

Finger abduction Finger adduction Froment’s sign

L=lateral two lumbricals

O=Opponens pollicis

A=abductor pb

F=flexor pollicis brevis

Thumb abduction

Long thoracic◦ Stabilization of scapula in pushup

Rhomboid◦ Hands on hips, resisted rearward movement of

elbow Suprascapular

◦ ?

A. Deltoid

B. Supraspinatous and infraspinatous

Initial arm abduction

IR of shoulder

Axillary nerve innervates the deltoid

Root Movements Reflex

L1, 2 Hip flex None

L3,4 Knee ext, dorsiflex Patellar

L5 Ext great toe None

S1 Hip ext, knee flex, plantarflex Ankle

Movement Muscle Nerve Root

Hip flex Iliopsoas Sacral plexus L1,2

Hip ext Glut max Inf glut nerve L5, S1

Knee ext Quad Femoral nerve L3,4

Knee flex Hamstrings Sciatic nerve L5, S1

Dorsiflex Tib ant Deep peroneal nerve L4,5

Plantarflex Gastroc Post tib nerve S1

Hip abd Glut med/min Sup glut nerve L4,5

Hip add Adductors Obturator nerve L2,3

Eversion Peroneus long Superf peroneal n L5, S1

Let’s have a break.