Part 2 book “Atlas of adult physical diagnosis” has contents: Neurologic examination, knee examination, shoulder examination, hand, wrist, and thumb examination, elbow examination, hip, back, and trunk examination, foot and ankle examination, skin examination, eye examination. | 07/18/05 10:41 AM Page 161 ■ Neurologic Examination 7 PRACTICE AND TEACHING OVERALL EXAMINATION Overall neurologic examination includes the thorough assessment of power, tone, reflexes, cranial nerves, and function of the sensory structures. Power Assessment The neurologic examination includes the assessment of the power, also known as strength of various muscle groups. Two muscle groups from the proximal upper and lower extremities should be examined. Shoulder elevation or shrugging against resistance is assessed for proximal muscle strength, trapezius muscle function, and cranial nerve (CN) XI function (Fig. ). For this assessment, the patient actively elevates the shoulders, ., shrugs, while the examiner applies resistance; feel the trapezius muscle. Arm extension is assessed for triceps function, radial nerve, and root C7 (Fig. ). For this, the patient’s arm is passively abducted to horizontal (90 degrees), forearm dangling down at the elbow; the patient then actively extends the forearm at the Figure . Technique for power assessment of proximal upper extremities: elevation of shoulders. TIPS Figure . ■ Active shoulder elevation or Technique for power assessment of triceps and proximal arm: extension of elbows. shrugging: apply resistance to tops of the scapula ■ Trapezius contraction ■ Proximal muscle problems: bilateral weakness TIPS ■ With patient’s arm abducted to 90 degrees, forearm dangling at the side, actively extended at elbow: apply resistance to the distal forearm ■ Triceps muscle contraction ■ Radial nerve or root of C7 problem: unilateral paresis, fasciculations, and even atrophy of the triceps muscle ■ Proximal muscle weakness: bilateral paresis 161 07/18/05 10:41 AM Page 162 162 Chapter 7 Figure . Technique for power assessment of proximal hip. A. Forward flexion of hip with patient standing. B. Patient supine. TIPS ■ Patient standing (A), or supine (B),
