Expansion
Inspection, tone, power, reflexes, coordination, sensation, gait
Expansion
- Inspection: posture, wasting, fasciculation, involuntary movements, tremor, scars, pes cavus, and the position of the limbs at rest
- Tone: passive movement at each joint, with clonus at the ankle. Look for spasticity (velocity dependent, clasp knife, pyramidal), rigidity (constant, lead pipe or cogwheel, extrapyramidal) or hypotonia
- Power: graded by the MRC scale, tested against gravity then resistance, comparing sides, moving proximal to distal
- Reflexes: biceps, supinator, triceps in the arm; knee, ankle and plantar in the leg. Reinforce with Jendrassik’s manoeuvre before calling one absent
- Coordination: finger to nose, dysdiadochokinesia, heel to shin, rebound
- Sensation: light touch and pinprick (spinothalamic), vibration and joint position sense (dorsal column), plus temperature if indicated
- Gait, and Romberg’s test
MRC power grading
| Grade | Finding |
|---|---|
| 0 | No movement |
| 1 | Flicker of contraction |
| 2 | Movement with gravity eliminated |
| 3 | Movement against gravity |
| 4 | Movement against resistance, reduced |
| 5 | Normal |
Interpret by pattern rather than by individual findings. The key question is whether the lesion is upper motor neurone, lower motor neurone, neuromuscular junction, muscle or sensory, and then where along the neuraxis it lies.