Tremor physical examination: Difference between revisions

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===Neuromuscular===
===Neuromuscular===
*Detailed [[Neuromuscular]] examination of [[patients]] with tremor should be detailedtremor, including its frequency, amplitude, pattern, and distribution, and to identify other neurologic findings if present..
*[[Patients]] are usually oriented to persons, place, and time. Detailed [[neuromuscular]] [[examination]] of [[patients]] with tremor should include:
OR
*[[Muscle]] rigidity: Cogwheel rigidity  
*Patient is usually oriented to persons, place, and time
*[[Bradykinesia]]: Slow movement, occurs in [[Parkinsons disease]].
* Altered mental status
*Abnormal gait: Rombergs test
* Glasgow coma scale is ___ / 15
*Unilateral/bilateral tremor:[[Frequency]], [[amplitude]], [[pattern]], [[distribution]].
* Clonus may be present
*Finger-to-nose test / [[Dysmetria]]
* Hyperreflexia / hyporeflexia / areflexia
*[[Dysdiadochokinesia]] (palm tapping test)
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
===Extremities===

Revision as of 03:25, 31 January 2021

Tremor Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]

Overview

Physical examination of patients with tremor varies depending on the cause of tremor.

Physical Examination

Physical examination of patients with tremor varies depending on the cause of tremor.

Appearance of the Patient

Vital Signs

Skin

  • Skin examination of patients with tremor is usually normal.

HEENT

Neck

Lungs

  • Pulmonary examination of patients with tremor is usually normal.

Heart

  • Cardiovascular examination of patients with tremor is usually normal.

Abdomen

  • Abdominal examination of patients with tremor is usually normal.

Back

  • Back examination of patients with [disease name] is usually normal.

OR

  • Point tenderness over __ vertebrae (e.g. L3-L4)
  • Sacral edema
  • Costovertebral angle tenderness bilaterally/unilaterally
  • Buffalo hump

Genitourinary

Neuromuscular

Extremities

  • Assess for rigidity and bradykinesia by flexing and extending the patient's arms, seeking signs of cogwheel rigidity.
  • Extremities examination of patients with is very important:

OR

  • Clubbing
  • Cyanosis
  • Pitting/non-pitting edema of the upper/lower extremities
  • Muscle atrophy
  • Fasciculations in the upper/lower extremity

References

  1. Sharma S, Pandey S (2016). "Approach to a tremor patient". Ann Indian Acad Neurol. 19 (4): 433–443. doi:10.4103/0972-2327.194409. PMC 5144461. PMID 27994349.
  2. 2.0 2.1 Smaga S (2003). "Tremor". Am Fam Physician. 68 (8): 1545–52. PMID 14596441.

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