These two photos (Figures 1 and 2) show wasting of the left small hand muscles including the interosseous muscles, 3rd and 4th lumbricals and hypothenar muscles. The picture also shows an ulnar claw hand in which there is extension of the metacarpophalangeal joints and flexion of the proximal and distal interphalangeal joints of the 4th and 5th digits. This pattern of wasting is compatible with an ulnar neuropathy.
These two videos are from a middle-aged man presenting with progressive bilateral lower limb and right upper limb weakness for few months. In the first video, there are prominent fasciculations over the entire right upper limb. Whilst in the second video, fasciculations can also be noted over both lower limbs, but more prominent on the…
The knee-jerk, ankle-jerk and plantar reflexes are being examined in this patient. There is a slight down-going plantar reflex on the right side. Otherwise, all other reflexes are absent. Discussion of the sign Areflexia may indicate deficits in the reflex loop. This may be due to a lesion involving the sensory neuron or the lower motor…
This is a video from a middle-aged man with myotonic dystrophy type 1, an autosomal dominant multi-systemic disorder that not only affects the muscles, but also causes other problems such as cataracts, arrhythmias and diabetes mellitus. The video shown here is typical of myotonia which can be seen in these patients. The tone is usually…
These two videos are from a middle-aged man presenting with progressive bilateral lower limb and right upper limb weakness for few months. In the first video, there are prominent fasciculations over the entire right upper limb. Whilst in the second video, fasciculations can also be noted over both lower limbs, but more prominent on the…
In this video, one can appreciate that the patient has a lower motor neuron type of weakness affecting the right facial nerve. On asking the patient to look upwards (stimulation of the frontalis muscles), one can appreciate the lack of wrinkles over the forehead on the right side compared with the left. On asking the…
This patient presented with a few week history of progressive weakness affecting the four limbs associated with muscle pain. He found it increasingly difficult to lift up his arms to above his shoulder level and also to climb stairs. There was in addition unintentional weight loss of 20 pounds (baseline of 180 pounds) during the…