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Diabetic Exam
 
 
 
 
Diabetic Exam
Poor diabetic control may manifest in many different ways, with macrovascular and microvascular complications. The diabetic examination is useful for diagnosing these complications, particularly when it comes to the vascular and neurologic examination of the lower limb.
 

Power Assessment

 
 

Overview

  • Power assessment is a key part of the motor examination, and can be used to identify focal or global weakness.
    • How to Assess

    • Ask the patient to move their fingers, thumb, wrist, elbow and shoulder through each movement.
  • Start by asking the patient to move against resistance (5 / 4). If the patient cannot move against resistance, ask them to move the joint against gravity (3). If they still cannot move the joint, eliminate gravity (2). In the absence of signficant movement of the joint look for flicker movement (1 / 0). Grade as appropriate, comparing both sides.
    • Interpretation

    • 0/5: No movement
    • 1/5: Flicker of movement
    • 2/5: Movement without gravity
    • 3/5: Movement against gravity
    • 4/5: Against weak resistance
    • 5/5: Normal power
    • Causes of Weakness

    • CNS lesion - results in decreased power with increased tone and reflexesIschaemia, SAH / ICH, tumour, trauma, encephalitis, vasculitis, MS, ADEM, PML, sarcoidosis, prions
    • Nerve root pathology - loss of a single myotomeTrauma, radiculopathy, neoplasm
    • Focal peripheral nerve pathology - in the muscles supplied by a single nerveTrauma, entrapment, focal ischaemia, sarcoidosis, neoplasia, Bell’s palsy (face)
    • Peripheral neuropathy (axonal polyneuropathy)Diabetes, motor neuron disease, hypothyroidism, B12 / folate deficiency, alcoholism, connective tissue disease, amyloid / sarcoidosis, toxins
    • Peripheral demyelinationGuillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy (CIDP), Charcot-Marie-Tooth
    • Neuromuscular pathologyMyasthenia gravis, amyloidosis
    • Muscular pathologyPolymyositis, rhabdomyolysis
Last updated on December 1st, 2019
 
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