Electrophysiological evaluation: Basic principles and clinical applications
Jacques Corcos, David Ginsberg, Gilles Karsenty in Textbook of the Neurogenic Bladder, 2015
The BCR reflex has been said to be of value in patients with cauda equina and other LMN lesions, although it is recognized that a reflex with a normal latency does not exclude the possibility of an axonal lesion in its reflex arc (Figure 39.7). The sensitivity and specificity of sacral reflex responses in patients with conditions associated with neurogenic bladders are not known. In diabetics, the nerve conduction studies performed in limbs are more sensitive in revealing peripheral neuropathy than sacral reflex latencies.60 Abnormally short reflex latency of the sacral reflex has been claimed to suggest whether the abnormally low position of conus medullaris in the tethered cord syndrome61 or a suprasacral cord lesion.62 Mechanical stimulation has been used to elicit sacral reflex in both sexes53 and has been found to be a robust technique. Either a standard commercially available reflex hammer or a customized electromechanical hammer can be employed. Such stimulation is painless and can be used in children.30 The latency of the mechanically elicited BCR is similar to the electrically elicited one (Figure 39.6).30
History Taking and Physical Examination
John Greene, Ian Bone in Understanding Neurology a problem-orientated approach, 2007
The following reflexes should be tested: Biceps (C5, C6): examiner’s thumb or finger is placed firmly on the biceps tendon and the examiner’s fingers are struck with the reflex hammer.Triceps (C6, C7): the patient’s upper arm is supported and the patient’s forearm is allowed to hang free; the triceps tendon is struck above the elbow.Brachioradialis (C5, C6): the patient’s forearm rests on their abdomen or lap and the radius is struck about 3–5 cm (1–2 inches) above the wrist.Abdominal (T8, T9, T10, T11, T12): a blunt object is used to stroke the patient’s abdomen lightly on each side in an inward and downward direction above (T8, T9, T10) and below the umbilicus (T10, T11, T12), while noting contraction of the abdominal muscles with deviation of the umbilicus towards the stimulus.Knee (L2, L3, L4): the patient sits or lies down with the knee flexed and the patellar tendon is struck just below the knee.Ankle (L5 S1): the patient’s foot is dorsiflexed at the ankle and the Achilles tendon struck.
Musculoskeletal system
Abderrahman Zouhir, Abdulqadir Abdulkarim in Medical Arabic, 2020
تعتبر آلام الظهر من الأمور الشائعة بين الناس ويبدو أنَّ أسباباً كثيرة وراء هذه الآلام منها التوتر العضلي أو ما نسميه بالشدّ العضلي Muscular tension نتيجة لرفع ثقل بشكل غير متوازن وصحيح مما يؤدي إلى حدوث تلك الآلام. وقد تعود تلك الآلام إلى مشاكل في البنية التركيبية لمبنى الظهر كأن تكون هناك فقرة بارزة يؤدي وضعها غير الطبيعي إلى الضغط على عصب معين فيسبب آلاماً تنتقل باتجاه الأطراف السفلى بشكل شديد وقد تؤدي إلى ما يسمى ب Sciatica. وقد تكون الانحناءات أو التحدّب غير السليم في العمود الفقري Scoliosis وراء آلام الظهر مرض هشاشة العظام Osteoporosis والأورام السرطانية في العمود الفقري والتدخين وزيادة الوزن وبذل جهود كثيرة أثناء العمل أو الاكتئاب. يجري الأطباء الفحوصات اللازمة بواسطة مطرقة المنعكسات Reflex hammer وغيرها من فحوصات التقييم كالتصوير الشعاعي X-Ray أو MRI أو التصوير المقطعي المحوسب CT لمعرفة الأسباب الكامنة وراء آلام الظهر وبناء على ذلك قد يصف الأطباء بعض الأدوية والمراهم لعلاج الالتهابات أو ينصحون بالعلاج الطبيعي. بعض الناس الذين يعانون من آلام الظهر الشديدة أو المزمنة قد يحتاجون لإجراء عمليات جراحية. من أجل تجنب آلام الظهر وينصح الأطباء بإجراء تمارين رياضية منتظمة والامتناع عن التدخين والمحافظة على وزن الجسم والابتعاد عن السمنة وإتباع نمط حياتي صحي. (*)
Jean-Martin Charcot´s medical instruments: Electrotherapeutic devices in La Leçon Clinique à la Salpêtrière
Published in Journal of the History of the Neurosciences, 2021
Francesco Brigo, Albert Balasse, Raffaele Nardone, Olivier Walusinski
A closer look at these objects reveals they are something different. The French neurologist Guillaume-Benjamin-Amand Duchenne de Boulogne (1806–1875) had developed a noninvasive technique of muscle stimulation (localized electrization, électrisation localisée). He stimulated the muscles using a specific machine with cloth-covered electrodes and an induction coil to produce electricity. The machine was reproduced in detail in his work, On Localized Electrization and its Application to Pathology and Therapy (De l’Électrisation localisée et de son application à la physiologie, à la pathologie et à la thérapeutique; Duchenne de Boulogne 1855; see Figure 2). A closer look at the device in the painting reveals that it is not the apparatus invented by Duchenne. Furthermore, the shape of the second instrument is not that of a Skoda percussion hammer. More generally, it does not represent a reflex hammer at all, as the first medical hammer designed specifically to assess reflexes had not yet been invented (Lanska 1989).
Sepsis-associated encephalopathy and septic encephalitis: an update
Published in Expert Review of Anti-infective Therapy, 2021
Simone C. Tauber, Marija Djukic, Johannes Gossner, Helmut Eiffert, Wolfgang Brück, Roland Nau
Whereas focal neurological signs do not belong to the clinical picture of SAE, they are characteristic for SEE and SME. Therefore, repeated thorough neurological exams by experienced staff are mandatory in all patients with involvement of the central nervous system during sepsis. The neurological examination is a bedside test which requires basic equipment only: a flashlight, a reflex hammer, a device to apply pain stimuli (e.g., a spiky piece of wood), a tuning fork, and an ophthalmoscope. Simple scoring systems such as the Glasgow Coma Scale and the Confusion Assessment Method (CAM) are helpful to detect changes over time, but often are not sensitive enough to detect focal neurological signs. In SEE and SME, focal neurological signs depend on the localization of the lesions. Septic emboli frequently are located in the middle cerebral artery or its branches in both hemispheres.
Violins, medicine, and the art of listening
Published in Medical Teacher, 2019
The physician conducted a physical exam, asking the patient to do various motions. Hands raised to the ceiling, fingers wiggling in front, the occasional soft thud of a reflex hammer. The doctor excused herself from the room to speak with another musculoskeletal attending physician. She reenters the room with direct news.
Related Knowledge Centers
- Central Nervous System
- Peripheral Nervous System
- Reflex
- Tendon
- Thorax
- Plantar Reflex
- Neurological Examination
- Percussion
- Natural Rubber
- Handle