Neurological Examination of Limbs

Neurological Examination of Limbs

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Scope of the Site

This Website includes:

Descriptions of manual muscle (MMT), sensory and reflex tests.
Photographs of manual muscle, sensory and reflex tests.
Narrated movies of manual muscle, sensory and reflex tests.
Some narrated movies of patients with:
- Paresis/paralysis.
- Functional deficits due to paresis/paralysis.

This Website does not include:

Anatomical figures, which can be obtained from textbooks or websites.
Modern terminology. Most nomenclature is based on traditional anatomical terminology. I have used peroneal, peroneus and upper and lower trunk. If you prefer modern terminology, substitute fibular, fibularis and superior and inferior respectively.
Pin sensation. The areas tested for pin sensation are the same sites tested for touch sensation.

Links on the Home page:

Acknowledgements - includes the many patients, students, residents and faculty who have contributed to making this web site possible.
Bedside reminders - these are formatted to be printed out in as 3 X 5 cards to laminate.
Brachial and lumbosacral plexus labeled - line diagrams which can be displayed or printed.

How to Use the Site: Initial Search

To begin using the site, make the following selections from the right hand column of the Home page.

Select your specialty/medical school year:
Make your selection based on your clinical practice. I have assumed that:
- Specialists in Neurology, Orthopaedics, Physical Medicine and Rehabilitation, and Physical Therapy have similar interests.
- Occupational Therapists are interested in the upper limb examination.
- Primary care and third year medical students will be interested in a basic screening examination of the peripheral nervous system.
- First year medical students will have a more limited interest in the MMT.
Select a section: manual muscle tests, sensation tests or reflex tests. Then select a specific test from the dropdown menu displayed.

This main menu is available from all subsequent pages of the site. You may search for additional tests, change specialty, or select a new section, without returning to the Home page.

How to Use the Site: Test Pages

MMT, sensation and reflex test pages may include the following elements:

Test name and related information.
Black and white photographs illustrating the tests.
Video of test procedures.
Video of related examples. (Some tests have more than one example of related clinical problems. Click on arrows to cycle through multiple related examples.)
For MMT: Option to view plexus diagram with red lines identifying primary and blue lines identifying secondary innervation. Click on the link: Diagram: Plexus.
For MMT: Videos of muscle grading system - grading from 0 to 5.
For sensation tests: link to Sensation grading system text.
For reflex tests: link to reflex grading text.
Main Menu is included on all test pages (bottom left hand column).

How to Use the Site: Viewing Video

Select a video button on the left hand column of the test page. A dropdown menu will appear if there is more than one video for a topic. The selected video will appear in a pop-up window.
Activate the video by clicking on the "play" triangle. Adjust volume. Move cursor to bottom of video clip to pause or replay. You can advance or reverse the video clip, in the pause mode, by placing the cursor on the play bar and sliding the bar to the right or left. Move cursor off video clip to hide player bar (in most browsers).
Click the [x] to close the video pop-up window.

(NOTE: Internet Explorer requires the Adobe Flash Player plug-in for viewing the videos. If you are unable to access the videos you can download this plug-in at: http://get.adobe.com/flashplayer/)

1. Select your role (specialty/medical school year of training).
Medical Student, 1st Year
Medical Student, 3rd Year
Neurology
Occupational Therapy
Orthopaedic Surgery
Physical Medicine and Rehabilitation
Physical Therapy
Primary Care
Or, show alphabetical list of all choices

2. Select a section from the menu below to begin.

About This Website

The purpose of this website is to improve the clinician's skill in performing the manual muscle test (MMT) and sensory and reflex testing of the limbs. This website includes descriptions, photographs, and narrated video clips of these tests and of patients with related functional deficits.

First-time visitors should review the Introduction. This provides details on the organization and use of the site.

This work is a distillation of what I have come to use in clinical practice which began in 1962. I am sure having had polio as a teenager in 1953 has colored my approach. My exposure to a master clinician during three years of residency also colored my approach. I cannot emphasize enough, the influence Dr. Edward Delagi had, not only on me but on many clinicians over his long career which began during World War II.

Gerald J. Herbison, M.D.
Professor, Department of Rehabilitation Medicine
Jefferson Medical College
Thomas Jefferson University
Philadelphia, PA 19107
610.527.3556
Author's website

Acknowledgements | Bedside reminders (to print and laminate) | Brachial plexus labeled | Lumbosacral plexus labeled

(NOTE: Internet Explorer requires the Adobe Flash Player plug-in for viewing the videos. If you are unable to access the videos you can download this plug-in at: http://get.adobe.com/flashplayer/)

Maintained by Gerald J. Herbison, M.D., Department of Rehabilitation Medicine
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