neurological examination

Indications

• assessment of neurologic disease
  • motor function is low risk, high value means of assessing movement disorders

Procedure

Alertness, orientation

CN II-XII

• pupils, extra-ocular muscles, tongue (CN 12), gag, hearing (Weber & Rinne test)

DTR:

• biceps: flexion at elbow (C5, C6)
• triceps: extension at elbow (C6, C7)
• brachioradialis: flexion & supination of forearm (C5, C6)
• patellar: extension at knee (L2, L3, L4)
• ankle: plantar flexion at ankle (S1)
• Plantar flexion (Babinski)
• check for clonus
• check for tremor

motor:

• flexion at the elbow (C5, C6, biceps),
• extension at the elbow (C6, C7, C8, triceps)
• abduction at the shoulders (deltoids)
• shrugging of shoulders, turning of head (CN XI)
• extension at wrist (C6, C7, C8, radial nerve)
• handgrip (C7, C8, T1),
• finger abduction (C8, T1 & ulnar nerve)
• opposition of thumb (C8, T1 & median nerve)

gait (if possible)

• rise from a sitting position without arm support
• heel to toe or tandem walk
• walk on toes: tests plantar flexion
• walk on heels: tests dorsiflexion

if gait not testable:

• flexion at the hip (L2, L3, L4, iliopsoas)
• adduction at the hips (L2, L3, L4, adductors)
• abduction at the hips (L4, L5, S1, gluteus medius & minimus)
• extension at the hips (S1, gluteus maximus)
• extension at the knee (L2, L3, L4, quadriceps)
• flexion at the knee (L4, L5, S1, S2, hamstrings)
• dorsiflexion at the ankle (L4, L5)
• plantar flexion at the ankle (S1)

finger to nose: tests for dysmetria (cerebellar)

heel to shin, repeat with eyes closed to check position sense

rapid alterating movements: tests for dysdiadochokinesis (cerebellar)

sensory:

• position sense
• vibratory sensation
• Romberg
• pronator drift
• stereognosis
• 2 point discrimination: 5 mm on finger pads

More general terms

• physical examination

Additional terms

• nerve root