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Muscle Weakness: A vague complaint of debility, fatigue, or exhaustion attributable to weakness of various muscles. The weakness can be characterized as subacute or chronic, often progressive, and is a manifestation of many muscle and neuromuscular diseases. (From Wyngaarden et al., Cecil Textbook of Medicine, 19th ed, p2251)
 JoVE Medicine

Adapted Resistance Training Improves Strength in Eight Weeks in Individuals with Multiple Sclerosis

1Motion Analysis Laboratory, Kennedy Krieger Institute, 2Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, 3Johns Hopkins University School of Medicine, 4Department of Neurology, Johns Hopkins University School of Medicine


JoVE 53449

 JoVE Neuroscience

The Neuromuscular Junction: Measuring Synapse Size, Fragmentation and Changes in Synaptic Protein Density Using Confocal Fluorescence Microscopy

1Physiology and Bosch Institute, University of Sydney, 2Motor Neuron Disease Research Group, Australian School of Advanced Medicine, Macquarie University, 3Advanced Microscopy Facility, Bosch Institute, University of Sydney


JoVE 52220

 JoVE Biology

Tissue Triage and Freezing for Models of Skeletal Muscle Disease

1Division of Pediatric Pathology, Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, 2Department of Physiology and Cell Biology, The Ohio State University, 3Department of Human Nutrition, Foods and Exercise, Virginia Tech, 4Division of Biomedical Informatics, Department of Biostatistics, Department of Computer Science, University of Kentucky, 5Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, 6Cure Congenital Muscular Dystrophy, 7Joshua Frase Foundation, 8Department of Rehabilitation Medicine, University of Washington, 9Department of Physiology, University of Arizona


JoVE 51586

 Science Education: Essentials of Physical Examinations III

Motor Exam I

JoVE Science Education

Source: Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

Abnormalities in the motor function are associated with a wide range of diseases, from movement disorders and myopathies to strokes. The motor assessment starts with observation of the patient. When the patient enters the examination area, the clinician observes their ability to walk unassisted and their speed and coordination while moving. Taking the patient's history provides an additional opportunity to observe for evidence of tremors or other abnormal movements, such as chorea or tardive dyskinesia. Such simple but important observations can yield valuable clues to the diagnosis and helps to focus the rest of the examination. The motor assessment continues in a systematic fashion, including inspection for muscle atrophy and abnormal movements, assessment of muscle tone, muscle strength testing, and finally, the examination of the muscle reflexes and coordination. The careful systematic testing of the motor system and the integration of all the findings provide insight to the level at which the motor pathway is affected, and also help the clinician to formulate the differential diagnosis and determine the course of the subsequent evaluation and treatment.

 Science Education: Essentials of Physical Examinations III

Cranial Nerves Exam II (VII-XII)

JoVE Science Education

Source: Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

The cranial nerve (CN) examination follows the mental status evaluation in a neurological exam. However, the examination of the cranial nerves begins with observations made upon greeting the patient. For example, weakness of the facial muscles that are innervated by the cranial nerve VII can be readily apparent during the first encounter with the patient. Cranial nerve VII, the Facial nerve, also has sensory branches, which innervate the taste buds on the anterior two-thirds of the tongue and the medial aspect of the external auditory canal. Therefore, finding ipsilateral taste dysfunction in the patient with facial weakness confirms the involvement of CN VII. In addition, knowledge of the neuroanatomy helps the clinician to localize level of the lesion: unilateral weakness of the lower facial muscles suggests a supranuclear lesion on the opposite side, while lesions involving the nuclear or infranuclear portion of the facial nerve, manifest with an ipsilateral paralysis of all the facial muscles on the involved side. Cranial nerve VIII, the Acoustic nerve, has two divisions: the hearing (cochlear) division, and the vestibular division, which innervates

 Science Education: Essentials of Physical Examinations III

Motor Exam II

JoVE Science Education

Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

There are two main types of reflexes that are tested on a neurological examination: stretch or deep tendon reflexes, and superficial reflexes. A deep tendon reflex (DTR) results from the stimulation of a stretch-sensitive afferent from a neuromuscular spindle, which, via a single synapse, stimulates a motor nerve leading to a muscle contraction. DTRs are increased in chronic upper motor neuron lesions (lesions of the pyramidal tract) and decreased in lower motor neuron lesions and nerve and muscle disorders. There is a wide variation of responses and reflexes graded from 0 to 4+ (Table 1). DTRs are commonly tested to help localize neurologic disorders. A common method of recording findings during the DTRs examination is using of a stick ure diagram. The DTR test can help distinguish upper and lower motor neuron problems and can assist in localizing nerve root compression as well. Although the DTR of nearly any skeletal muscle could be tested, the reflexes that are routinely tested are: brachioradialis, biceps, triceps, patellar, and Achilles (Table 2). Superficial reflexes are segmental reflex responses that result from stim

 JoVE Bioengineering

Measurement of Maximum Isometric Force Generated by Permeabilized Skeletal Muscle Fibers

1Department of Orthopaedic Surgery, University of Michigan Medical School, 2Department of Molecular & Integrative Physiology, University of Michigan Medical School, 3Department of Biomedical Engineering, University of Michigan Medical School, 4Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School


JoVE 52695

 JoVE Biology

Isometric and Eccentric Force Generation Assessment of Skeletal Muscles Isolated from Murine Models of Muscular Dystrophies

1Department of Anatomy and Cell Biology, School of Dental Medicine, University of Pennsylvania, 2Department of Physiology, Perelman School of Medicine, University of Pennsylvania, 3Department of Anatomy and Cell Biology, School of Dental Medicine, School of Dental Medicine, University of Pennsylvania


JoVE 50036

 JoVE Medicine

Human Vastus Lateralis Skeletal Muscle Biopsy Using the Weil-Blakesley Conchotome

1Academic Geriatric Medicine, University of Southampton, University Hospital Southampton, 2National Institute for Health Research Southampton Biomedical Research Center, University of Southampton and University Hospital Southampton NHS Foundation Trust, 3MRC Lifecourse Epidemiology Unit, University of Southampton, 4National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, 5National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, 6Newcastle University Institute of Ageing and Institute of Health and Society, Newcastle University


JoVE 53075

 JoVE Developmental Biology

Analysis of Zebrafish Larvae Skeletal Muscle Integrity with Evans Blue Dye

1Program in Genetics & Genome Biology, The Hospital for Sick Children, 2Department of Molecular Genetics, The University of Toronto, 3Program in Genomics of Differentiation, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 4Departments of Pediatrics and Neurology, University of Michigan


JoVE 53183

 JoVE Immunology and Infection

In Situ Detection of Autoreactive CD4 T Cells in Brain and Heart Using Major Histocompatibility Complex Class II Dextramers

1School of Veterinary Medicine and Biomedical Sciences, University of Nebraska, Lincoln, 2Center for Biotechnology, University of Nebraska, Lincoln, 3Nebraska Center for Virology and School of Biological Sciences, University of Nebraska, Lincoln


JoVE 51679

 Science Education: Essentials of Physical Examinations III

Shoulder Exam II

JoVE Science Education

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

The shoulder exam continues by checking the strength of the rotator cuff muscles and biceps tendons. The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) act as compressors, holding the humeral head in place against the glenoid. Injury and degeneration of the rotator cuff tendons are the most common source of shoulder pain. The strength testing of the rotator muscle is performed by testing motions against resistance applied by the examiner. Pain with these resisted motions suggests tendonitis; weakness suggests a rotator cuff tear. The strength tested is followed by tests for impingement syndrome, shoulder instability, and labrum injury. It is important to test both of the shoulders and compare between the sides. The opposite shoulder should be used as the standard to evaluate the injured shoulder, provided it has not been injured as well.

 JoVE Medicine

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea

1Clinical and Biological Sciences Department, Neurology Unit, University of Torino, San Luigi Gonzaga Hospital, 2Oncology Department, Radiology Unit, University of Torino, San Luigi Gonzaga Hospital, 3Clinical and Biological Sciences Department, Dietologic and Nutrition Unit, University of Torino, San Luigi Gonzaga Hospital


JoVE 54606

 Science Education: Essentials of Physical Examinations III

Hand and Wrist Exam

JoVE Science Education

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

The wrist is a complex joint made up of 8 carpal bones and their numerous articulations and ligaments. Overlying the wrist are the tendons and muscles of the hand and fingers. The hand is made up of 5 metacarpal bones and the tendons that run to the hand overlie these bones. Finally, the fingers consist of 14 phalanges with their articulations held together by collateral ligaments and volar plates. Common mechanisms of both acute and chronic wrist injury include impact, weight bearing (which can occur in gymnastics), twisting and throwing. The osteoarthritis of the hand commonly affects distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints, while rheumatoid arthritis (RA) is seen in the metacarpophalangeal (MCP) and PIP joints. It is important to compare the injured wrist or hand to the uninvolved side. Key aspects of the wrist and hand exam include inspection, palpation for tenderness or deformity, testing the range of motion and strength, neurovascular assessment, ligaments and tendon testing and the special tests.

 Science Education: Essentials of Physical Examinations III

Ankle Exam

JoVE Science Education

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

The ankle and foot provide the foundation for the body and the stability needed for our upright posture and ambulation. Because of its weight-bearing function the ankle joint is a common site of injury among athletes and in the general population. Ankle injuries occur as a result of both acute trauma and repetitive overuse (such as running). The ankle is a fairly simple joint, consisting of the articulation between the distal tibia and talus of the foot, along with the fibula on the lateral side. The ankle is supported by numerous ligaments, most notably the deltoid ligament on the medial side, and laterally by three lateral ligaments (anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL)). Physical examination of the ankle and the patient history (including the mechanism of the injury and the location of pain provide diagnostic information that helps the physician to pinpoint specific structures involved in an injury, and are essential for determining the severity of the injury and the subsequent diagnostic steps. When examining the ankle, it is important to closely compare the injured ankle to the uninvolved side. Essential components of the ankle exam in

 Science Education: Essentials of Physical Examinations III

Cranial Nerves Exam I (I-VI)

JoVE Science Education

Source: Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

During each section of the neurological testing the examiner uses the powers of observation to assess the patient. In some cases cranial nerve dysfunction is readily apparent: a patient might mention a characteristic chief complaint (such as loss of smell or diplopia), or a visually evident physical sign of cranial nerve involvement, such as in facial nerve palsy. However, in many cases a patient's history doesn't directly suggest cranial nerve pathologies, as some of them (such as sixth nerve palsy) may have subtle manifestations and can only be uncovered by a careful neurological exam. Importantly, a variety of pathological conditions that are associated with alterations in mental status (such as some neurodegenerative disorders or brain lesions) can also cause cranial nerve dysfunction, therefore any abnormal findings during a mental status exam should prompt a careful and complete neurological exam. The cranial nerve examination is applied neuroanatomy. The cranial nerves are symmetrical, therefore while performing the examination each side should be compared to the other. A physician should approach the examination in a systematic fashion an

 JoVE Cancer Research

Intra-iliac Artery Injection for Efficient and Selective Modeling of Microscopic Bone Metastasis

1Lester and Sue Smith Breast Center, Baylor College of Medicine, 2Department of Molecular and Cellular Biology, Baylor College of Medicine, 3Graduate Program in Developmental Biology, Baylor College of Medicine, 4Department of Molecular and Human Genetics, Baylor College of Medicine, 5McNair Medical Institute, Baylor College of Medicine, 6Dan L. Duncan Cancer Center, Baylor College of Medicine


JoVE 53982

 Science Education: Essentials of Developmental Biology

Tissue Regeneration with Somatic Stem Cells

JoVE Science Education

Somatic or adult stem cells, like embryonic stem cells, are capable of self-renewal but demonstrate a restricted differentiation potential. Nonetheless, these cells are crucial to homeostatic processes and play an important role in tissue repair. By studying and manipulating this cell population, scientist may be able to develop new regenerative therapies for injuries and diseases.

This video first defines somatic stem cells, and then explores the role these cells play in tissue regeneration. This is emphasized in a description of a protocol that isolates muscle satellite cells and uses them to repair muscle damage in a mouse model of muscular dystrophy. Finally, we discuss specific tissue regeneration studies utilizing somatic stem cells.

 Science Education: Essentials of Physical Examinations III

Neck Exam

JoVE Science Education

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

Examination of the neck can be a challenge because of the many bones, joints, and ligaments that make up the underlying cervical spine. The cervical spine is composed of seven vertebrae stacked in gentle C-shaped curve. The anterior part of each vertebra is made up of the thick bony body, which is linked to the body above and below by intervertebral discs. These discs help provide stability and shock absorption to the cervical spine. The posterior elements of the vertebra, which include the laminae, transverse, and spinous processes and the facet joints, form a protective canal for the cervical spinal cord and its nerve roots. The cervical spine supports the head and protects the neural elements as they come from the brain and from the spinal cord. Therefore, injuries or disorders affecting the neck can also affect the underlying spinal cord and have potentially catastrophic consequences. The significant motion that occurs in the neck places the cervical spine at increased risk for injury and degenerative changes. The cervical spine is also a common source of radicular pain in the shoulder. For this reason, the neck should be evaluated as a routine part of every shoulder exam.

 Science Education: Essentials of Physical Examinations III

Foot Exam

JoVE Science Education

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

The foot is a complex structure comprised of numerous bones and articulations. It provides flexibility, is the essential contact point needed for ambulation, and is uniquely suited to absorb shock. Because the foot must support the weight of the entire body, it is prone to injury and pain. When examining the foot, it is important to remove shoes and socks on both sides, so that the entire foot can be inspected and compared. It is important to closely compare the injured or painful foot to the uninvolved side. The essential parts of the evaluation of the foot include inspection, palpation (which should include vascular assessment), testing of the range of motion and strength, and the neurological evaluation.

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