Assessing Tone | Diabetic Exam - MedSchool
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Diabetic Exam

Assessing Tone



    • How to Assess

    • Ask the patient to relax and allow you to move their upper limbs. Move the shoulder, elbow, wrist and fingers passively through their range of motion, looking for rigidity. Repeat to assess the lower limbs.
    • Interpretation

    • Spacticity (clasp knife): velocity dependant, quick flexion / extension of the joint (works best on knee / elbow)Upper motor neuron lesion
    • Lead pipe rigidity: continuous and not velocity dependant, slow flexion / extensionParkinsonism / Parkinson’s disease, contractures
    • Cogwheel rigidity: rigidity associated with tremor, resulting in jerky stop / start movement of the jointParkinsonism / Parkinson’s disease
    • Normal: minimal resistance
    • Decreased: no resistanceLower motor neuron or cerebellar lesion


    • How to Elicit

    • Move the ankle joint several times to ensure that it is relaxed, and then sharply dorsiflex the joint. Count the number of rhythmic muscle contractions (beats) that occur in response to this stimulus.
    • Significance

    • Indicative of an upper motor neuron lesion.
Last updated on November 28th, 2019