Spinal Cord |
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Cervical Spondylosis |
Look at back |
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Syringomyelia |
Test sensation over cap area, look for Horners |
Anterior Horn Cell |
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Motor Neuron Disease |
Fasiculation of the tongue or other muscles, ?bulbar speech |
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Polio |
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Spinal muscular atrophy |
Examination of lower limbs |
Nerve Lesions |
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Median |
Alone will not give wasting of all small muscles of the hand |
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Ulnar |
Should have a claw hand |
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Peripheral Neuropathy |
e.g. CMT – absent reflexes, forearms > hands, thickened nerves |
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Brachial Plexus |
? clubbed from lung ca, cervical ribs, |
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Myopathy |
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Myotonic Dystrophy |
Appearance, weak neck muscles |
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Distal myopathy |
e.g. inclusion body myositis |
So if you see someone with wasted small muscles of the hand (s) – Step back look at their face for ptosis, balding and Horners. Shake their hand noting the myotonia. Carry out your standard upper limb neurological exam. Look at their back. Expose their feet taking a quick glance. Remember that a lot of the above give motor findings only, the presence of sensory findings over the hands may indicate a peripheral neuropathy or root/ nerve lesion.