Pronator drift

In medicine, pronator drift (also known as pyramidal drift) refers to a pathologic sign seen during a neurological examination.[1] Jean Alexandre Barré is credited with having first described it; thus it is sometimes known as the Barré test or sign. A positive result indicates spasticity. This sign can appear due to an upper motor neuron lesion[2][3] or various other conditions (including inborn errors of metabolism) which include spasticity as a symptom.

Description

The patient is asked to hold both arms fully extended at shoulder level in front of them, with the palms upwards, and hold the position. If they are unable to maintain the position the result is positive. Closing the eyes accentuates the effect, because the brain is deprived of visual information about the position of the body and must rely on proprioception. Tapping on the palm of the outstretched hands can accentuate the effect.

Interpretation

This is a test of upper motor neuron disease.

If a forearm pronates, with or without downward motion, then the person is said to have pronator drift on that side reflecting a contra-lateral pyramidal tract lesion. In the presence of an upper motor neuron lesion, the supinator muscles in the upper limb are weaker than the pronator muscles, and as a result, the arm drifts downward and the palm turns toward the floor. A lesion in the ipsilateral cerebellum or ipsilateral dorsal column usually produces a drift upward, along with slow pronation of the wrist and elbow.

References

  1. ↑ Anderson NE, Mason DF, Fink JN, Bergin PS, Charleston AJ, Gamble GD (April 2005). "Detection of focal cerebral hemisphere lesions using the neurological examination". J. Neurol. Neurosurg. Psychiatry. 76 (4): 545–9. doi:10.1136/jnnp.2004.043679. PMC 1739581. PMID 15774443.
  2. ↑ Pronator drift. gpnoebook.co.uk. URL: http://www.gpnotebook.co.uk/simplepage.cfm?ID=503709725. Accessed On: October 23, 2008.
  3. ↑ "The Precise Neurological Exam". Retrieved 2009-11-28.
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