Examine the upper and
lower limbs of this patient and arrive at a diagnosis.
First greet the
examiner and confirm your identity.
Read the scenario
carefully and try to find out exactly what is required of you as well as look
for any obvious clues in the history.
Now Greet the patient and introduce your self and
explain the purpose of todays”s consultation that you want to examine the
patient to arrive at a diagnosis and ask if patient is comfortable and ensure
you will maintain his comfort and dignity during the examination and take his
consent / permission for examination and proceed.
Inspection :
Look at face of patients for any obvious clinical findings
related to neurological disorders eg
Frontal balding : Myotonic dystrophy
Mask like facies in Parkinsonism
Facial twitching
Any signs of facial nerve palsy etc
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Neck:
Any scar marks on back / nape of neck and back.
Any wasting of muscles of shoulder girdle ( Fascio scapula
muscular dystrophy ) or any generalized
wasting and fasciculations etc
Upper limbs and lower
limbs
Now complete the routine of examining Gait, Motor
system examination of upper and lower
limbs including power ,and Sensory system examination ( Soft and pin
sensations, Vibration and proprioception )and reflexes(
Biceps,triceps,brachioradialis,plantars,knee and ankle jerks).
Any wasting of muscles of upper limbs and any deformities.
Any wasting or deformities of muscles of lower limbs.
In this case which is a patient of Charcot Marie Tooth Disease,following would be found :
Motor system
examination : Muscle weakness in their feet, ankles, legs and hands
Gait : An awkward
way of walking
Feet : Highly
arched or very flat feet
Sensations :
numbness in the feet, arms and hands
Main symptoms of CMT
The main symptoms of CMT usually appear between the ages of
5 and 15, although they sometimes do not develop until well into middle age or
later.
Some of the main
symptoms of CMT include:
Muscle weakness in the feet, ankles and legs at first
Feet that are very highly arched, which can make the ankle
unstable, or having very flat feet
Curled toes (hammer toes)
Gait
An awkward or high step and difficulty using the ankle
muscles to lift the foot, which makes walking more difficult
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Sensory system examination
A lack of sensation in the arms and feet
Cold hands and feet caused by poor circulation
Wasting of the muscles in the lower legs, causing legs to
have a distinctive "upside-down champagne bottle" shape
Feeling tired a lot of the time as a result of the extra
effort it takes to move around
Some people also develop additional problems, such as:
Uncontrollable shaking (tremor)
Abnormal curvature of the spine (scoliosis)
Problems speaking, breathing or swallowing (dysphagia) –
these symptoms are rare in CMT
Later symptoms of CMT
As CMT progresses, the muscle weakness and lack of sensation
gets worse and starts to affect hands and arms more.
This can lead to problems with both manual dexterity and
hand strength, making tasks like doing up the buttons of a shirt very
difficult.
Persistent problems with walking and posture can put
excessive strain on body, which often
leads to muscle and joint pain.
Less commonly, damaged nerves may also cause pain, known as
neuropathic pain.
Problems with mobility and walking tend to get worse with
age. It's uncommon to lose the ability to walk completely, but older people
with CMT often need a walking aid to get around.
