1. MOTOR SYSTEM EXAMINATION (Strength ) Moderator – Dr. V.K. GOEL Presenter- Dr. Harmeet Riyait

2. POWER OF MUSCLES QUICK ASSESSMENT – 1. Patient working 2. Standing up from lying & sitting position 3. Dressing or undressing 4. Lightly jumping or hopping

6. MUSCLES OF SHOULDER GIRDLE & SCAPULA Test – The patient flexes his elbow, holds the elbow to his side and then attempts to turn the fore arm backwards against resistance Peripheral Nerve – Suprascapular Mains Segmental Supply – C5 INFRA SPINATUS Test – Ask the patient to abducted from 30º to 60º the arm against examiner resistance Peripheral Nerve – Circumflex Main Segmental Supply - C5 DELTOID Test – The patient tries to initiate abduction of the arm from the side against resistance Peripheral Nerve – Suprascapular Main Segmental Supply – C5 SUPRA SPINATUS

7. If seratous anterior is weak, scapular medial borden will become prominent – winging of scapula Test Push the wall by his hands keeping elbow extended Main Seg supply C5C6C7 P. Nerve – N. to serratus anterior SERRATUS ANTERIOR Test-2 Strech the arm out infront & than to clasp the hands together while examiner endeavour to hold them apart Test-1 Placing the hand on hip and pressing in wards Main Seg supply C5C6C7 P. Nerve – Lat. & medial pectoral N. PECTORALIS MAJOR

8. Test-2 Resist the patient’s attempt to adduct the arm when abducted to above 90º Test-1 While palpating the muscle, ask the patient to cough Main Seg supply C7 P. Nerve –Nerve to L. Dorsi LATISSIMUS DORSI

11. MUSCLES OF ELBOW JOINT Test – Pt. attempts to extend the elbow against resistance Peripheral Nerve – Radial Mains Segmental Supply – C7 TRICEPS Test – Pt. pronates the forearm and draws the thumb towards the nose against resistance Peripheral Nerve – Radial Main Segmental Supply - C5C6 BRACHIORADIALIS Test – Pt. flexes his elbow against resistance, the forearm being supinated Peripheral N. – Musculo cutaneous Main Segmental Supply – C5 BICEPS

12. MUSCLES OF FOREARM & WRIST JOINT Peripheral Nerve - Ulnar Mains Segmental Supply – C8 FLEXOR CARPI ULNARIS Test – Examiner resist the patient attempt to flex the wrist towards the radial side Peripheral Nerve – Median Mains Segmental Supply – C6C7 FLEXOR CARPI RADIALS Test – Examiner attempt to flex the patients extended fingers at metacarpophalangeal joints Peripheral Nerve – Radial Main Segmental Supply -C7 EXTENSOR DIGITORUM Test – Pt. holds the fingers partialy extended and dorsiflexes the wrist towards the radial side against resistance Peripheral N. – Radial Main Segmental Supply – C6C7 EXTENSOR CARPI RADIALIS LONGUS

13. MUSCLES OF THUMB Test – Patients attempt to extend the thumb while the examiner attempts to flex it at the interphalangeal joint Peripheral Nerve – Radial Mains Segmental Supply – C8 EXTENSOR POLLICIS LONGUS Test – Pt. attempts to extend the thumb while the examiner attempts to flex it at MCP joint Peripheral Nerve – Radial Main Segmental Supply - C8 EXTENSOR POLLICIS BREVIS Test – Pt. attempts to maintain his thumb in abduction against the examiner resistance Peripheral N. – Radial Main Segmental Supply – C8 ABDUCTOR POLLICIS LONGUS

14. Test – Patient attempt to flex the distal phalanx of the thumb against the patient resistance (Hold the proximal phalanx) Peripheral Nerve – Median Mains Segmental Supply – C8 FLEXOR POLLICIS LONGUS Test – Ask the patient to abduct the thumb in a plane at right angle to the palmar aspect of index finger against the resistance of examiner thumb Peripheral Nerve – Median Main Segmental Supply - T1 ABDUCTOR POLLICIS BREVIS Test – Pt. attempts to touch the little finger with the thumb Peripheral N. – Median Main Segmental Supply – T1 OPPONENS POLLICIS

16. MUSCLES OF HAND & FINGERS Pt. Tries to Adduct the fore finger against resistance Pt. Tries to abduct the fore finger against resistance Peripheral nerve ulnar Main Seg supply T1 IST DORSAL INTEROSSI & IST PALMAR INTROSSI B. Interossi – Pt. attemps to keep the fingers abducted against resistance A. Lumbricals – Pt. Tries to flex the extended fingers at the MCP Joints Median – Lumbical I & II Ulnar – lumbrical III & IV & interossi Main Seg supply C8 T1 LUMBRICAL & INTEROSSI

17. thank you Test – Back of hand is placed on the table & little finger abducted against resistance (sign of ulnar N. lesion) P. N. – Ulnar Mains Segmental Supply – T1 ABDUCTOR DIGITI MINIMI Test – Pt. Flexes the terminal phalanx of the fingers against resistance, the middle phalanx being supported P. N. – Median Ist & IInd Ulnar IIIrd & IVth Main Segmental Supply - C8 FLEXOR DIGITORUM PROFUNDUS Test – Pt. flexes the finger at the proximal inter phalangel joint against resistance (examiners fingers placed on middle phalanx) Peripheral N. – Median Main Segmental Supply – C8 FLEXOR DIGITORUM SUBLIMIS

23. Hip joint and lower limb

33. Summary- upper limb Small ms of hand. T1 Finger flexors C8 Triceps Finger extension, elbow extension C7 supinator Elbow flexion (semipronated) C6 Biceps Shoulder abduction, elbow flexion C5 REFLEX MOVEMENTS ROOT

35. Lower limb Ankle reflex Hip extension, knee flexion, plantar flexion. S1 Dorsiflexion of foot, inv & eversion of ankle, extn of great toe. L5 Knee reflex Knee extension L3, L4 Hip flexion L1, L2 Reflex Movement Root

36. Thank you