The Neurological Examination

Part II – Motor System Examination and Coordination

Dante P. Bornales, MD, MHPEd

Fellow of the Philippine Neurological Association
 The Neurological Examination

Always include the following in the

Motor System examination:

General Inspection of the Motor System

Muscle tone

Muscle Strength – Manual Muscle Testing

Coordination

Your task: recall UMN and LMN lesions and signs

Inspection

When inspecting, look for:

6. Wasting/Atrophy
- a reduction of the muscle bulk in certain muscles compared with
other muscle groups
- wasted muscles are frequently weak
 Always compare the
symmetry of muscles!

Observe!
muscle atrophy
of the thenar muscle
of the left hand
Inspection

When inspecting, look for:

2. Body position/s
3. Scars
- may indicate previous injury/ies or surgery, which may have affected
a nerve or the muscle itself
Inspection

When inspecting, look for:

4. Fasciculations
- seen as rippling or twitching of muscles at rest

5. Involuntary movements
- look for jerks, tremors, dystonia, other dyskinesias
- describe the abnormal movements
Whenever possible,

always check for the patient’s “gait”

1. ask the patient to walk in his usual fashion, with arms on the
side

2. observe for patient’s posture, the pattern of the arm and

leg movements, and the control of the trunk

3. if normal, ask:
heel-toe walk
stand on his toes and heels without support
hop! (most patients with significant weakness
cannot hop)
Muscle Tone

Tone – “how floppy or stiff a limb feels”

Some patients may have difficulty relaxing during the exam, which
can artificially increase stiffness in their limbs. Always do your
utmost effort to put them at ease!
Testing for muscle tone
Testing for muscle strength
 MRC Scale for grading muscle strength
0 No movement

1 Flicker of muscle when pt. tries to move

2 Moves, gravity eliminated

3 Moves against gravity but not against

resistance
4 Moves against resistance but not to full
strength
5 Full strength (cannot overcome the
movement)
Testing for shoulder adduction and abduction
Testing for flexion (C5-C6 – biceps) and extension ((C6-8)
at the elbow
Testing for extension at the wrist (C6-8, radial nerve)
Testing for extension and flexion at the wrist
Testing for hand grip (C7-8, T1)
Testing for finger abduction (C8-T1, ulnar nerve)
Testing for opposition of the thumb ( C8, T1, median nerve)
Testing for flexion at the hip L2-4, iliopsoas)
Testing for extension at the hips (S1, gluteus maximus)
Testing for adduction (L2-4, adductors) and abduction (L4-5, S1,
Gluteus maximus and medius) at the hips
Testing for flexion at the knee (L4-5, S1-2, hamstrings
Always remember to compare the symmetry of both sides
Testing for extension at the knee (L2-4, quadriceps)
Variation (sitting) in testing
for the hip flexion

Variation (sitting) in testing

for knee extension
Variation in the position to
test for knee flexion
Testing for dorsiflexion (L4-5) and plantar flexion (S1)
End of segment