Transcript PowerPoint Sunusu

21.May.2014. Wednesday
Great extensor of the leg
Femoral nerve
Quadriceps femoris
 Performed with the person in
the supine position with the
knee partly flexed.
 Person extends knee against
resistance.
Hamstring muscles
Extension @ hip joint
Flexion @ knee joint
Tibial nerve
 Person flexes his leg against
resistance.
 Normally, these muscles—
especially their tendons on each
side of the popliteal fossa—should
be prominent as they bend the
knee.
Dorsiflexes ankle & inverts foot
Deep fibular nerve
Tibialis anterior
 The person is asked to stand on the heels or
dorsiflex the foot against resistance.
 If normal, its tendon can be seen and palpated.
Extensor hallucis longus
Extends great toe & dorsiflexes
ankle
Deep fibular nerve
 Great toe dorsiflexed against
resistance.
 If acting normally, its entire tendon
can be seen and palpated.
Extensor digitorum longus
 Lateral four toes dorsiflexed
against resistance.
 If acting normally, the tendons can
be seen and palpated.
Extends the toes & dorsiflexes
foot at the ankle joint
Deep fibular nerve
Fibularis longus and brevis
Everts foot and weakly plantarflexes
ankle
Superficial fibular nerve
 The foot is everted strongly against resistance.
 If acting normally, the muscle tendons can be seen and palpated
inferior to the lateral malleolus.
Initial Position
Patient plantar flexes and everts foot
Final Position
Examiner forces the foot into inversion
Triceps surae
Plantarflexes ankle; raises heel during walking;
flexes leg at knee joint (soleus; steadies leg on
foot)
Tibial nerve
 The foot is plantarflexed against resistance (e.g., by “standing on
the toes,” in which case body weight [gravity] provides
resistance).
 If normal, the calcaneal tendon and triceps surae can be seen and
palpated.
Flexor hallucis longus
Flexes great toe at all joints; weakly
plantarflexes ankle; supports medial
longitudinal arch
Tibial nerve
 The distal phalanx of the great toe is flexed against resistance.
 If normal, the tendon can be seen and palpated on the plantar
aspect of the great toe as it crosses the joints of the toe.
Flexor digitorum longus
Flexes lateral four digits;
plantarflexes ankle; supports
longitudinal arches of foot
Tibial nerve
 The distal phalanges of the lateral four toes are flexed against
resistance.
 If they are acting normally, the tendons of the toes can be seen
and palpated.
Plantarflexes ankle; inverts foot
Tibial nerve
Tibialis posterior
 The
. foot is inverted against resistance with foot in slight
plantarflexion.
 If normal, the tendon can be seen and palpated posterior to the
medial malleolus
Superior clunial nerves
L1-L3 posterior rami
Skin overlying superior and
central parts of buttock
Medial clunial nerves
S1-S3 posterior rami
Skin of medial buttock and
intergluteal cleft
Inferior clunial nerves
Posterior cutaneous nerve of
thigh (S2-S3)
Skin of inferior buttock
(overlying gluteal fold
Upper lateral quadrant
lateral branches of the iliohypogastric (L1) and 12th thoracic
nerves (anterior rami)
Obturator nerve
Superior medial thigh
Genitofemoral nerve
Middle anterior thigh
Posterior cutaneous nerve of
the thigh
Posterior aspect of the thigh
Intermediate cutaneous nerve
of the thigh (femoral nerve)
Variable area on the medial
aspect of the thigh
Medial cutaneous nerve of the
thigh
(femoral nerve)
Medial aspect of the thigh
Saphenous nerve (femoral nerve)
Medial aspect of leg
Superficial fibular nerve
Anterolateral leg
Posterior cutaneous nerve of the thigh
Upper part of the leg
Sural nerve
Posterolateral leg
Medially saphenous nerve, which
extends distally to the head of 1st
metatarsal
Superiorly (dorsum of foot) superficial
(primarily) and deep fibular nerves
Inferiorly (sole of foot) medial and
lateral plantar nerves; Common border
of their distribution along the 4th
metacarpal toe or digit
Laterally sural nerve, including part of
the heel.
Posteriorly (heel) medial and lateral
calcaneal branches of the tibial and
sural nerves, respectively
Patellar Reflex L3 & 4
A tap with a tendon hammer on the patellar ligament
Calcaneal Tendon Reflex S1 & 2
Person's legs are dangling over the side of the
examining table. The calcaneal tendon is struck briskly
with a reflex hammer just proximal to the calcaneus.
The normal result is plantarflexion of the ankle joint.
NEUROLOGICAL EXAM
Online resources
NeuroLogic Examination Videos and Descriptions...an Anatomical
Approach
The Precise Neurological Exam
Neuroexam
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The Neurological Examination
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The Neurological Examination
Neurologic Exam