Vicarious movements or trick movements_AB.pdf

Vicarious movements or trick movements_AB.pdf

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  Vicarious movements Dr. ArunimaBiswas
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  CONTENTS  What aretrick movements?  Types of trick movements  Examples of each type of trick movement  References
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  Definition  Unnatural movementsseen when muscle is paralyzed or inhibited  It is taking over of the action of a paralyzed prime mover by another group of muscles  It is also known as substitution movement
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  Types of trickmovements 1. Direct/ indirect substitution 2. Accessory insertion 3. Tendon action 4. Rebound 5. Gravity 6. Anomalous nerve supply
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  1. Direct/ indirectsubstitution A. Another prime mover will substitute for paralyzed prime mover muscle  E.g. weakness/ paralysis of supinator muscle Muscle substituted Trick movement Biceps brachii Supination along with elbow flexion
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  B. Fixator musclewill produce movement for prime mover/ agonist muscle  E.g. weak/ paralyzed hip abductors Muscle substituted Trick movement Lateral abdominals Pelvis elevation
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  C. Other favourablemuscles placed in the region will contract to position the joint in a new position so that the other muscle performs the test motion in the new modified position  E.g. Deltoid paralysis Favourable muscle New position Other muscle External rotators Externally rotate Biceps will contract to produce shoulder abduction
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  D. Other musclemay contract to assist the weak muscle  E.g. Weakness/ paralysis of Biceps Muscle substituted Trick movement Shoulder flexors Shoulder flexes during elbow flexion
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  2. Accessory insertion The insertion of muscle is such that when the muscle contracts, it helps to perform movements of the weak/ paralyzed muscles  E.g. weakness/ paralysis of EPL Substituted muscle Insertion Trick movement APB & FPB Base of proximal phalanx & extensor expansion Extension of thumb
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  3. Tendon action Occurs in two joint or multi joint muscles  Shortening of a tendon when antagonist muscle contracts strongly  E.g. weakness/ paralysis of long finger flexors Trick movement Passive insufficiency Tendon action Wrist extension Wrist flexors Finger flexion
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  4. Rebound  Phenomenonof seeming contraction in the agonist when the antagonist contracts strongly & the relaxes quickly  E.g. weakness/ paralysis of long finger flexors Antagonist contraction Trick movement EPL & ED Finger flexion
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  5. Gravity  Patientwill shift the body part so that gravity assists the weak muscles to do the movement  E.g. weak/ paralyzed triceps Shifting of body part Trick movement Shoulder abducted to 90° Shoulder depression & external rotation
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  6. Anomalous nervesupply  20% of all normal people have anomalous nerve supply in the hand  These motor anomalies may/not be associated with an anomaly of sensory supply and may not be bilateral or symmetrical  E.g. Median nerve palsy Muscle action Anomalous innervation Opponens pollicis, 2nd & 3rd lumbricals, & FPB Ulnar nerve
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  References  Parry CBW.Trick Movements. Proceedings of the Royal Society of Medicine. 1970;63(7):674-676  Kendall, F. (2005). Muscle Testing & Function with Posture & Pain (5th edition). Lippincott Williams & Wilkins.  Avers, D. (2019). Daniels & Worthingham’s Muscle Testing, Techniques of Manual Examination & performance Testing (10th edition). Elsevier.
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  THANK YOU