How is motor examination done for multiple sclerosis (MS)?

The motor examination for MS is done in the same way that a neurologist would approach any motor exam. They look first at muscle bulk and tone. The muscle bulk is typically fine in MS but the tone is extra stiff in affected muscles. One could develop decreased bulk from disuse but typically atrophy is not a major problem. Then the neurologist will look for weakness with confrontational testing which assesses strength through resistance against the examiner.
Louis Rosner
The motor examination includes looking at the muscles for shrinkage (atrophy), swelling (hypertrophy), and twitching (fasciculations). Muscle tone in the limbs, which may be too loose or too tight, is checked by asking the patient to relax and let each arm and leg be moved back and forth in a swinging motion. Strength in the limbs is tested by having the patient hold the limb against resistance at each joint. Movements at the shoulders, elbows, wrists, hands, hips, knees, ankles, and toes are checked, comparing each side and taking into account the patient's dominant side and general build.

Hand coordination is evaluated by the finger-to-nose test (the patient touches the doctor's finger and own nose) and by the performance of rapid alternating movements (turning the hand over and back, closing and opening the fist in rapid succession, or touching the thumb to each finger up and down the line). Coordination in the leg is evaluated by the heel-knee-shin test, in which the patient is asked to run the right heel down the left shin from knee to ankle and the left heel down the right shin from knee to ankle.

In a spinal cord attack, the doctor may find weakness and increased tone (spasticity) in one or both legs and occasionally in one or both arms. Weakness and spasticity in a limb may also occur with a brain stem or cerebral lesion, but more often in multiple sclerosis (MS), the doctor localizes the trouble to the spinal cord. In a brain stem-cerebellar attack, the findings may include wavering of the finger on the finger-to-nose test (intention tremor), slowness and clumsiness of the hand in doing rapid alternating movements (dysdiadochokinesis), and zigzagging or jerkiness of the foot on the heel-knee-shin test (dysmetria). A limb that shows one or more of these signs of incoordination is said to be ataxic.

Multiple Sclerosis

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Multiple Sclerosis

Too often, multiple sclerosis is thought of only as "the crippler of young adults." But in fact, 75 percent of all people with MS will never need a wheelchair. In Multiple Sclerosis, Dr. Louis J....

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