Tri-10 Wk10 Day? - Wednesday, March 14, 2012

3 days, 20 hours, 18 minutes until Part III - interspersed focused study needed.

I'll be using the Part III Study Prep guide obtained from NBS to help with the focus.

NMS Exam consist of 13% of our exam

1. Posture & Gait knowledge

2. Ortho & Neuro Test purposes

3. Peripheral vascular conditions especially TOS, claudication and RSDS.

RSDS is kind of a favorite of mine.

DR CUMA

Drop Wrist - Radial Nerve

Claw Hand - Ulnar Nerve

Median Nerve - Ape Hand

I remember there is a ddx on the Claw Hand -

Claw Hand, Ulnar nerve, Tunnel of Guyon

Dupuytren's - flexed 4th & 5th digit - Hereditary, red ropey fascia

Volkmann's - flexed 4th & 5th digit - Post Trauma

Parkinson's - Parkinsonian Gait - Seen in the basal-ganglia defects of Parkinson disease. Posture is stopped, with flexion of head, arms, hips and knees. Patients are slow getting started. Steps are short & shuffling with involuntary hastening (festination). Arm swings are decreased and patients turn around stiffly (all in one piece). Postural control is poor (retropulsion)

Key Words: Propulsion / Festinating / Shuffling / Mincing, Rigid, subthalamic, forward leaning posture w/ small shuffling steps.

Scissors Gait - Seein in spinal cord disease cuasing bilateral lower extremity spasticity including adductor spasm and abnormal proprioception. Gait is stiff. Patients advance each leg slowly and the thighs tend to cross forward on each other at each step. Steps are short. Patients appear to be walking through water.

ddx - Cerebral Palsy / adductor spasm, Knees together (ddx from waddling (MD) in which knees are apart)

Waddling (hip flexors) - Muscular Dystrophy -

L4 - Steppage Gait - Seen in food drop, usually secondary to peripheral motor unit disease. Patients either drag the feet or lift them high with knees flexed and bring them down with a slap onto the floor thus appearing to be walking up stiars. They cannot walk on their heels. The steppage giat may involve one or both legs Tibialis anterior and toe extensors are weak.

Key Words/ ddx - L4, Anterior Compartment Syndrome (ACS), foot drop, L4 Lesion / paresis of tibialis anterior

L5 - Gluteus Medius Lurch - Lateral sway over the weight bearing leg

S1 - Glueteus Maximus Lurch - AP sway (leans back during mid stance)

Spastic Hemiparesis - Seen in corticospinal tract lesion in stroke, causing poor control of flexor muscles during swing phase. Affected arm is flexed, immobile and held close to the side, with elbow, wrists and interphalangeal joints flexed. Affected leg extensors spastic; ankle plantar-flexed and inverted. Patients may drag toe, circle leg stiffly outward and forward (circumduction) or lean trunk to contralateral side to clear affected leg during walking.

Slappage gait - Sensory Ataxia - posterior column disease; sensory ataxia (difficulty walking in the dark) gait is unsteady with a wide base (feet wide apart) patients throw their feet forward and outward adn bring them down, first on the heels and ten on hte toes with a double tapping sound. They watch the ground for guidance when walking. With eyes closed, they cannotstand steadily with their feet together (positive Romberg sign) and the staggering gait worsens.