Exam Procedures
Motor System:
- Inspects bulk and tone
- Grades major muscle group power by MRC scale
- Shoulder abduction
- Elbow flexion (C5, C6-biceps)
- Elbow extension (C6, C7, C8-triceps)
- Wrist flexion/extension (C6, C7, C8, radial nerve)
- Hand grip (C7, C8, T1)
- Hip flexion (L2, L3, L4-iliopsoas)
- Knee flexion (L4, L5, S1, S2-hamstrings)
- Knee extension (L2, L3, L4-quadriceps)
- Ankle dorsiflexion (mainly L4, L5)
- Plantar flexion (mainly S1)
Deep tendon reflexes (DTRs)
- Biceps (C5, C6), triceps (C6, C7)
- Brachioradialis (C5, C6)
- Knee/Quadriceps (L2, L3, L4), Ankle/Gastrocnemius (primarily S1)
- Plantar response/Babinski sign (L5, S1)
Sensory System:
- Evaluates sensory loss by complaint focused exam
- Assesses joint position sensation at fingers and toes
- Assesses vibration threshold at one finger and big toe
Gait/Station/Cerebellar System:
- Evaluates rapid alternating movements
- Assesses precision of finger-nose-finger movements
- Evaluates for a Romberg sign
- Observes patient’s gait, assesses tandem walking
General Notes
Muscle Strength is graded on a 0 to 5 scale.
- 0 - No muscular contraction detected
- 1 - A barely detectable flicker or trace of contraction
- 2 - Active movement of the body part with gravity eliminated
- 3 - Active movement against gravity
- 4 - Active movement against gravity with some resistance
- 5 - Active movement against gravity with full resistance without evident fatigue. This is normal muscle strength.
Deep Tendon Reflexes (DTRs)
- 4+ Very brisk, hyperactive with clonus (rhythmic oscillations between flexion and extension)
- 3+ Brisker than average; possibly but not necessarily indicative of disease
- 2+ Average; normal
- 1+ Somewhat diminished; low normal; hypoactive
- 0 No response
Write-up Examples
- Mental Status: Alert, relaxed, and cooperative. Thought process coherent. Oriented to person, place, and time.
- Cranial Nerves: I—not tested; II through XII intact.
- Motor: Good muscle bulk and tone. Strength 5/5 throughout.
- Cerebellar: Rapid alternating movements, finger-to-nose, heel-to-shin intact. Gait with normal base. Romberg–maintains balance with eyes closed. No pronator drift.
- Sensory: Light touch, position, and vibration intact.
- Reflexes: 2+ and symmetric with plantar reflexes downgoing.