Examination of the upper limbs

Question 1

Observation:

Answer 1

Look for:

• Scars
• Skeletal deformity
• Wasting of the muscles (i.e atrophy)
• Involuntary movements (ballismus, chorea+athetosis, dystonia, ticks)
• Fasciculation
• Tremor (physiological, parkinsonian)

Question 2

Muscle tone:

Answer 2

• Ask about pain
• Tell the patient to relax

Test tone by performing passive movement of:

• Elbow flexion and extension
• Forearm pronation and supination
• Wrist flexion and extension

(Access both sides, the tone may be NORMAL, increased or decreased)

Question 3

Power:

Answer 3

To test power:

• Shoulder abduction
• Elbow flexion and extension
• Wrist flexion and extension
• Finger flexion and extension
• Intrinsic muscles of the hand

Question 4

Co-ordination:

Answer 4

Ask the patient to stretch out their hands. Look for:

• Postural tremor
• Dystonia
• Finger-nose test
• Rapid alternating hand movements

Question 5

Reflexes:

Answer 5

Test the following reflexes:

• Biceps
• Triceps
• Supinator

Question 6

Sensation:

Answer 6

Sensation can be tested by:

• Light touch
• Pinprick
• Vibration
• Joint position sense