Examination of a patient with Paraplegia
Paraplegia is an impairment in motor or sensory function of the lower extremities
HISTORY OF PRESENT ILLNESS
DATE OF ONSET
MODE OF ONSET Sudden gradual
PRECIPITATING FACTORS SPINAL INJURY VACCINATION
• EVOLUTION OF PARALYSIS
PROGRESS OF PARALYSIS
A. Increasing in severity and extent-cord compression.
B. Improving-inflammation,acute transverse myelitis or multiple sclerosis.
C. Static but progressing very slowly-Degenerative lesions.
D. Waxing and waning-MULTIPLE SCLEROSIS
Degree And Duration Of Paralysis
Motor symptoms
HISTORY OF PAST ILLNESSTB,Fever,SyphilisHypertension,DM,alcoholismLymphadenopathy,pain in spineSIMILAR EPISODES(Multiple sclerosis)
FAMILY HISTORYHypertension,DMh/o paraplegia in other members of the
family-indicate hereditary paraplegia,paraplegia with hereditary ataxia or lathyrism
TB
ENQUIRY OF SENSORY SYMPTOMS
1. Loss of sensation2. Sense of CONSTRICTION3. Zone of hyperasthesia4. Root pain5. Sensation of pins and needles in lower
extremities
SPECIAL POINTS IN PHYSICAL EXAMINATION
1. GENERAL SURVEY Level of consciousness Decubitus Lymph nodes Pulse BP Respiration Temperature Oedema
SPINE EXAMINATION
1. KYPHOSIS 2. SCOLIOSIS
3.GIBBUS 4.SPINA BIFIDA
5.TENDERNESS
NERVOUS SYSTEM
Level of consciousness,alertness,orientation and co-operation
HIGHER FUNCTIONS1. Unconscious or alteration of consciousness,
delirium,photophobia 2. Behavioural abnormality with speech
defects
Cranial Nerve Examination
OlfactoryOpticAcuity of vision Field of visionColour visionOphthalmoscopy or FundoscopyOculomotor ,Trochlear and AbducensTrigeminal
FacialPalpebral fissure,frowning,eye
closure,nasolabial folds,angle of mouth,blowing,whistling,showing of teeth,dribbling of saliva
Power of individual facial muscleUpper half of face escaped or notTaste sensation of anterior 2/3 of tongue
VestibulocochlearGlossopharyngeal and VagusSpinal accesoryHypoglossal
CRANIAL NERVES
Search for optic atrophy-Friedreich’s ataxia,multiple sclerosis
VII th Nerve palsy –1.GBS 2.Lymphomatous
deposits producing unilateral or bilateral VIIth nerve palsy
MOTOR FUNCTIONS
BULK OF MUSCLE1. Inspection2. Palpation3. Measurement
Tone of muscleHypotoniaHypertonia1. Spasticity-pyramidal lesions2. Rigidity-extra-pyramidal lesions
POWER OF MUCLE
Muscle Nerve Root value
Method
Flexors of thigh
Femoral L 1,2,3 Patient lies supine.Hip is fully flexed and resists attempt to extend it
Adductors of thigh
Obturator L2-L4 Patient tries to bring legs together against resistance
Extensors of thigh
Inferior gluteal nerve
L5-S1 Patient lies prone and tries to raise the thigh against resistance
Abductors of thigh
Superior gluteal
L4-S2 Patient tries to abduct the thigh against resistance
Flexors of knee
Sciatic nerve L4L5 Lies prone and tries to flex knee against resistance
Extensors of knee
Femoral nerve
L3L4 Lies supine ,knees extended and examiner resists it.
GRADING OF MUSCLE POWERMEDICAL RESEARCH COUNCIL SCALE
Grade 0-Complete paralysisGrade 1-A flicker of contraction only(visible
or palpable)without any movement of joint.Grade 2-Movt. possible only after elimination
of gravity(side to side movt. of a limb).Grade 3-Movt. possible against gravity but
not against resistance.Grade 4-Movt. Possible against gravity plus
resistance but weaker than normalGrade 5-Normal power.
Co-ordination of lower limbs -If muscle power grade is 4 or aboveHeel knee testToe-finger test
Involuntary movements
SENSORY FUNCTION
Superficial –Pain,Touch and TemperatureDeep-Joint sense,position sense,pressure
sense ,vibration senseCortical sensation-Point
localisation,stereognosis
REFLEX
SUPERFICIAL AbdominalCremastricPlantarDEEP knee jerkAnkle jerkClonus
VISCERAL BladderBowelSwallowingTROPHIC CHANGES-Bed soresCEREBELLAR FUNCTIONAUTONOMIC FUNCTIONS
RESPIRATORY SYSTEM
GI TRACT AND GENITOURINARY SYSTEM
CVS
LYMPHORETICULAR SYSTEM
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