Clinical examination paraplegia

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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