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examination of the motor system includes inspection as well as assessment of muscle strength muscle tone muscle bulk and fine motor movements test and compare sides of the body whenever possible begin the motor exam with inspection most of the motor exam can be done with the patient sitting inspect for asymmetry and posture that could indicate muscle imbalance note any involuntary movements such as tremors or tics as well as their relationships to movement in position inspect the muscles for hattrup e hypertrophy and fasciculations inspect both proximal and distal muscles for example both the shoulders and hands in the hands specifically inspect the hypothenar and thenar eminence --is and the dorsal interosseous muscles which decrease in size with aging in normal people test strength by assessing resistance to force grade strength on a scale from zero to five as described in the text begin with the neck and progress caudally test strengthen neck extension with the chin on the chest ha