Upper Limb Neuro
 

Motor Assessment

 
 
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Overview

  • Neurological causes of weakness may be delineated into upper motor neuron (brain, brainstem or spinal cord) or lower motor neuron (nerve root, plexus or peripheral nerve) causes. These two broad groups manifest with specific findings elicitable on examination.
    • Causes of Weakness

    • Upper Motor Neuron

    • CNS lesions - decreased power with increased tone, clonus and reflexes.Ischaemia, SAH / ICH, tumour, trauma, encephalitis, vasculitis, MS, ADEM, PML, sarcoidosis, prions
    • Lower Motor Neuron

    • 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)
    • Axonal pathology (peripheral neuropathy)Diabetes, motor neurone disease, hypothyroidism, B12 / folate deficiency, alcoholism, connective tissue disease, amyloid / sarcoidosis, toxins
    • Peripheral demyelinationGuillain-Barré syndrome, Charcot-Marie-Tooth
    • Other

    • Neuromuscular pathologyMyasthenia gravis, amyloidosis
    • Muscular pathologyPolymyositis, rhabdomyolysis
    • Poor compliance with examination

The Motor Pathway

  • Upper Motor Nucleus
    Primary motor cortex (precentral gyrus)
     
    Central Pathway
    Corticobulbar tract
    (via cerebral peduncle)
    Decussation
    Medullary Pyramids
    Spinal Pathway
    Lateral corticospinal tract
     
    Lower Motor Nucleus
    Ventral horn at the level of entry into the spinal cord
     
    Neuromuscular Junction
     
     
    Muscle
 
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