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THE MOTOR SYSTEM

(APPLIED ANATOMY)

AN INTRODUCTION TO THE
PHYSICAL EXAMINATION
DR HAMIADJI

THE MOTOR SYSTEM


(APPLIED ANATOMY)

AN INTRODUCTION TO THE
PHYSICAL EXAMINATION
DR HAMIADJI

The Motor System consists of those parts of the Brain and Spinal Cord that control Skeletal
Muscles
There are 3 functional components (Pyramidal, Extrapyramidal, Cerebellar systems) and a
Common Motor Pathway (Motor neurons in nuclei of cranial nerves and anterior horn of spinal
cord = Lower Motor neurons)

Extrapyramidal
System

Pyramidal System

Cerebellar System

Gross, Automatic, Voluntary


Movements

Precise, Skilled, Voluntary


Movements

Monitoring, Modulating
Movements

1.
Corticospinal
2.
Corticobulbar
(Upper Motor Neuron)
Rigidity
Bradykinesia / Hyperkinesia
(Abnormal Movements)

Spasticity
Paresis / Paralysis
(Abnormal Reflexes)

Hypotonia / Asthenia
Asynergia
(Abnormal Coordination)

- Resting tremor
- Chorea
- Athetose
- Hemibalism etc.

Hoffmann
Tromner
Babinski
Openheim etc.

- Intention tremor
- Dysmetria
- Adiadochokinesia
- Dysarthria etc.

Nucleus / Anterior horn

Flaccid para/paresis
Hypo/Areflexia
Atrophy
Fasciculation

(Lower Motor Neuron)

COMMON MOTOR
PATHWAY

THE PYRAMIDAL SYSTEM

Corticobulbar

THE PYRAMIDAL SYSTEM

The corticospinal tract


originates, as the name implies,
from cerebral cortex: primary
motor cortex, but also several
adjacent, functionally related
areas. The axons cross the midline
at the junction between medulla
and spinal cord. They synapse
upon spinal cord motoneurons, but
also upon spinal interneurons in
dorsal as well as ventral horns.
The fibers in the tract are laid out
in an orderly map, both in
brainstem, as you will learn later,
and in spinal cord. In both
structures, fibers controlling the
arm are located more medially,
fibers controlling the leg are
located more laterally (see wiring
diagram that follows).

The pyramidal motor system


(corticospinal plus corticobulbar
tracts) originates from more than
just primary motor cortex, and
synapses on more than just lower
motor neurons.
The pyramidal motor system is the only
"straight-line" descending pathway.

The "extrapyramidal" motor


system, that is, the sum total of all

parts of the motor system other than


the pyramidal (and also excluding
the cerebellum, which is a thing
unto itself) descends in stages, with
several synaptic way stations or
intermediate integrating structures
on the way down.
Many descending pathways from
cerebral cortex do not join the
pyramidal system, but influence the
activity of the extrapyramidal system
by synapsing upon its intermediate
integrating structures.
The human extrapyramidal system
exerts its effect on voluntary
movement primarily by influencing
the activity of the pyramidal system!

The cerebellum is an important


part of the higher order motor
system. However, unlike the parts of
the motor system we have already
described, the cerebellum does not
itself initiate any movements.
Instead, the cerebellum has a
powerful ordering, regulating, and
patterning influence upon voluntary
movements initiated in the motor
areas of the cerebral cortex. We
infer this influence by observing how
voluntary motor functions are
altered, impaired, or even lost, in
specific lesions of the cerebellum
and/or its connections.

Common motor
pathway

Clasp-knife phenomenon.
Description of the abnormal way that
paralyzed limb muscles respond to
passive stretch after pyramidal tract
damage. Characteristically, the
greater the velocity of stretch, the
greater the resistance of the muscle.

MRC Scale for Grading Muscle


Strength
Score

Muscle Response

No Movement

Muscle belly moves but


the joint does not move

2
gravity

Joint moves with


eliminated

Joint moves against


gravity

Joint moves against


gravity and some
resistance

Full strength

Abnormal Reflexes on the


Upper Limb & Lower Limb:
- Tromner, Hoffmann
- Babinski, Chaddock,
Oppenheim

Levels of motor integration are of


clinical significance because injury
at levels 1-3 produces sharply
different patterns of reflex activity.
Level 1
Spinal cord transection that
disconnects all descending motor
tracts.
Level 2
Pontine transection that spares the
vestibulospinal (VS) and
reticulospinal (RES) tracts.
Level 3
Transection rostral to the red
nucleus that spares the
rubrospinal (RS) tract as well.

CHOREA

Dysfunctions to the Basal


Nuclei result in Abnormal
Movements

THE CEREBELLAR SYSTEM

Ataxia and dysmetria can be


demonstrated by the finger-tonose and heel-to-shin clinical
tests, which are easy for
neurologically normal patients
but impaired or impossible if
cerebellar function is
compromised. Such patients are
especially impaired in the
performance of rapid alternating
movements. The medical Greek
name for this is
adiadochokinesis or
dysdiadochokinesis (a = lost;
dys = impaired). There may be
scanning speech, i.e. ataxia of
the complex movements of lips
and cheecks, tongue, larynx,
and diaphragm involved in
speech.

Hemiplegic gait

Shuffling gait

Ataxic gait

GAITS

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Impulse

Presynaptic neuron

Vesicle

Transmitters
Synaptic cleft
Postsynaptic
neuron

Receptors

Postsynaptic activity

CELL BODY
Dendrites

Myelin sheath
AXON

Schwann cell

Synaptic terminals

Node of Ranvier

Nucleus

Synapses

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