Manobras Deficitárias - Semiologia Neurológica| Prof. Felipe Barros

Summary

This video explains the use of deficit maneuvers to assess neurological conditions in patients. It introduces three basic maneuvers: Mingazine and Barré for lower limbs, and the Arm Extension maneuver for upper limbs. The video emphasizes evaluating muscular asymmetries, comparing both sides of the body and assessing proximal vs. distal muscle strength. These tests help identify early signs of neurological issues by spotting subtle deficits that patients might not notice in daily life. The explanation also highlights the importance of using these maneuvers to diagnose conditions like Guillain-Barré syndrome, muscular dystrophies, and other neuromuscular disorders.

Takeaways

• 😀 Manobras deficitárias are used to assess deficits in muscle strength, specifically in neurological patients.
• 😀 Two types of manobras are applied to lower limbs: Mingazine and Barré.
• 😀 One manobra, called manobra dos braços estendidos, is used for evaluating upper limbs.
• 😀 Manobras deficitárias are used to detect asymmetries in strength, comparing one side of the body to the other.
• 😀 The main goal is to identify deficits in muscle strength in patients who are able to perform active resisted movements.
• 😀 When performing the Mingazine test, the patient must hold a position of triple flexion of the lower limbs and any weakness will be noted as either distal, intermediate, or proximal.
• 😀 If the Mingazine test cannot be performed, the Barré test is used, with the patient lying prone and bending their knees while maintaining a 90-degree flexion.
• 😀 The Barré test isolates the proximal muscles, allowing for easier assessment of intermediate and distal muscle strength, especially in patients with obesity or elderly individuals.
• 😀 The manobra dos braços estendidos tests for weakness in the upper limbs by having the patient extend their arms at 90-degree angles and observing for any drop or asymmetry.
• 😀 In all manobras, comparisons are made between the right and left sides of the body, and between proximal and distal muscle groups to detect potential neurological issues.

Q & A

What is the purpose of performing deficit maneuvers on a patient?

The purpose of deficit maneuvers is to assess any muscular deficits by comparing muscle strength between different regions of the body, such as between the left and right sides, and between proximal and distal muscle groups.

What are the three basic deficit maneuvers mentioned in the video?

The three basic deficit maneuvers are Mingazine, Barre, and the Extended Arms Maneuver, which are used for the lower and upper limbs respectively.

How is the Mingazine maneuver performed?

The Mingazine maneuver is performed by placing the patient in a triple flexion position: 90 degrees of hip flexion, 90 degrees of knee flexion, and the foot in a neutral position. The patient must sustain this position for one minute, during which weaknesses in the proximal, intermediate, or distal regions are observed.

When should the Barre maneuver be used instead of the Mingazine maneuver?

The Barre maneuver is used when the Mingazine maneuver cannot be performed, typically when the patient has difficulty sustaining the position due to age, obesity, or other factors that make the legs too heavy to hold.

What is assessed during the Barre maneuver?

During the Barre maneuver, the patient's ability to sustain knee flexion and the position of the leg is assessed. It evaluates the strength of the distal and intermediate muscles, isolating the proximal muscles to avoid confusion with weight-related issues.

How do you compare strength during deficit maneuvers?

Strength is compared by evaluating both sides of the body (right vs. left) and different muscle groups (proximal vs. distal). The focus is on identifying asymmetries or weakness patterns that may indicate neurological issues.

Why is it important to compare proximal and distal muscle strength?

It is important to compare proximal and distal muscle strength because some neurological conditions affect one group before the other. For example, certain myopathies or muscular dystrophies affect the proximal muscles first, and understanding this pattern helps in diagnosis.

What types of diseases are suggested by asymmetries in muscle strength between the two sides of the body?

Asymmetries in muscle strength between the two sides of the body could indicate conditions like stroke (cerebrovascular accidents), as well as various neurological disorders such as Guillain-Barré Syndrome, which typically affects distal muscles first.

How does the assessment of muscle strength in neurological patients differ from that in orthopedic patients?

In neurological assessments, the focus is on identifying small deficits or asymmetries in muscle strength that could indicate neurological disorders. In contrast, orthopedic assessments typically focus on evaluating overall muscle strength and joint functionality, without comparing muscle groups for neurological patterns.

What does the Extended Arms Maneuver assess, and how is it performed?

The Extended Arms Maneuver is used to assess muscle strength in the upper limbs. The patient is asked to extend both arms at 90 degrees with palms facing forward, and the evaluator observes for any asymmetry or weakness, such as the arms or hands dropping within a minute. The assessment compares the strength between the right and left sides of the body.