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Tibial Nerve: The medial terminal branch of the sciatic nerve. The tibial nerve fibers originate in lumbar and sacral spinal segments (L4 to S2). They supply motor and sensory innervation to parts of the calf and foot.

Motor Exam I

JoVE 10052

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 the patient's ability to walk unassisted and the 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 help 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.


 Physical Examinations III

Sensory Exam

JoVE 10113

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

A complete sensory examination consists of testing primary sensory modalities as well as cortical sensory function. Primary sensory modalities include pain, temperature, light touch, vibration, and joint position sense. Sensation of the face is discussed in the videos Cranial Nerves Exam I and II, as are the special senses of smell, vision, taste, and hearing. The spinothalamic tract mediates pain and temperature information from skin to thalamus. The spinothalamic fibers decussate (cross over) 1-2 spinal nerve segments above the point of entry, then travel up to the brainstem until they synapse on various nuclei in thalamus. From the thalamus, information is then relayed to the cortical areas such as the postcentral gyrus (also known as the primary somatosensory cortex). Afferent fibers transmitting vibration and proprioception travel up to medulla in the ipsilateral posterior columns as fasciculus gracilis and fasciculus cuneatus, which carry information from the lower limbs and upper limbs, respectively. Subsequently, the afferent projections cross over and ascend to the thalamus, and from there to the primary somatosensory cortex. The pattern of a


 Physical Examinations III

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


 Cancer Research

Kinematics and Ground Reaction Force Determination: A Demonstration Quantifying Locomotor Abilities of Young Adult, Middle-aged, and Geriatric Rats

1CullenWebb Animal Neurology & Ophthalmology Center, Riverview, NB, 2Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, 3Department of Comparative Biology and Experimental Medicine, University of Calgary, 4Department of Neuroscience, University of Calgary

JoVE 2138


 Neuroscience

Foot Exam

JoVE 10192

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

The foot is a complex structure composed 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 (ROM) and strength, and the neurological evaluation.


 Physical Examinations III

In Vivo Electrophysiological Measurement of the Rat Ulnar Nerve with Axonal Excitability Testing

1School of Medical Science, University of New South Wales, 2Department of Clinical Neurophysiology, Rigshospitalet and the Institute of Neuroscience and Pharmacology, University of Copenhagen, 3Prince of Wales Clinical School, University of New South Wales

Video Coming Soon

JoVE 56102


 JoVE In-Press

Motor Exam II

JoVE 10095

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 DTR examination is using a stick figure 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 ref


 Physical Examinations III

Lower Back Exam

JoVE 10177

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

The back is the most common source of pain in the body. Examination of the back can be a challenge due to its numerous structures, including the bones, discs, ligaments, nerves, and muscles-all of which can generate pain. Sometimes, the location of the pain can be suggestive of etiology. The essential components of the lower back exam include inspection and palpation for signs of deformity and inflammation, evaluation of the range of motion (ROM) of the back, testing the strength of the muscles innervated by the nerves exiting in the lumbar-sacral spine, neurological evaluation, and special tests (including the Stork test and Patrick's test).


 Physical Examinations III

Transplantation of Schwann Cells Inside PVDF-TrFE Conduits to Bridge Transected Rat Spinal Cord Stumps to Promote Axon Regeneration Across the Gap

1The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, 2Department of Materials Science and Engineering, New Jersey Institute of Technology, 3Department of Biomedical Engineering, New Jersey Institute of Technology, 4Department of Cell Biology, University of Miami Miller School of Medicine, 5Department of Neurological Surgery, University of Miami Miller School of Medicine

JoVE 56077


 Medicine

In Vivo Model for Testing Effect of Hypoxia on Tumor Metastasis

1Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, 2Department of Nursing, Georgetown University, School of Nursing and Health Studies, 3Department of Human Science, Georgetown University, School of Nursing and Health Studies, 4School of Medicine, Georgetown University Medical Center, 5Department of Pathology and Neuropathology, Medical University of Gdańsk, 6Department of Oncology, Georgetown University Medical Center, 7Department of Pathology, Georgetown University Medical Center

JoVE 54532


 Cancer Research

Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury

1Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VAMC, 2Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, 3Deceased, Department of Kinesiology, The University of Georgia, 4Department of Physical Medicine and Rehabilitation, Penn State Milton S. Hershey Medical Center

Video Coming Soon

JoVE 57000


 JoVE In-Press

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A Rat Tibial Growth Plate Injury Model to Characterize Repair Mechanisms and Evaluate Growth Plate Regeneration Strategies

1Department of Bioengineering, Department of Orthopedics, University of Colorado Anschutz Medical Campus, 2Department of Orthopedics, University of Colorado Anschutz Medical Campus, 3Department of Chemical & Biological Engineering, Colorado School of Mines, 4Department of Orthopedics, Gates Center for Regenerative Medicine, University of Colorado Anschutz Medical Campus

JoVE 55571


 Medicine

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Partial Optic Nerve Transection in Rats: A Model Established with a New Operative Approach to Assess Secondary Degeneration of Retinal Ganglion Cells

1Aier School of Ophthalmology, Central South University, Changsha, China, 2Institute of Immunology, Tsinghua University School of Medicine, Beijing, China, 3Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China, 4Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China

JoVE 56272


 Neuroscience

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Using Retinal Imaging to Study Dementia

1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 2Department of Medicine & Therapeutics, The Chinese University of Hong Kong, 3Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, 4Gerald Choa Neuroscience Centre, The Chinese University of Hong Kong, 5Memory Aging and Cognition Centre, National University Health System, 6Department of Pharmacology, National University of Singapore, 7Singapore Eye Research Institute, Singapore National Eye Centre, 8Duke-NUS Medical School, National University of Singapore

JoVE 56137


 Medicine

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