Examination of upper limbs

Question 1

Steps in examination of upper limbs

Answer 1

1. Look
   • Ask child to stretch out the ULs, note the movement
   • Finger tip –> palm –> forearm –> arm –> shoulder
   • Nail - dystrophy, atrophy
   • Polydactyly / Syndactyly
   • Skin - trophic change, ulcer, vasomotor change, rash, subcutaneous calcifications
   • Joint - inflammatory changes, deformity
   • Asymmetry of size
   • Evidence of systemic disease
   • • Cirrhosis - clubbing, liver palm
   • • Throtoxicosis - tremor, clubbing
   • • Collagen vascular disease
   • • SBE - splinter haemorrhage, Janeway node
2. Examination of related system

• Neurological: Feel for the muscle bulk, fasciculation, asymmetry of size
• • Examine the tone, power, reflexes and coordination
• • Test sensory function: pain, touch, position and vibration
• Musculoskeletal: Joint examination
• • Inflammation, deformity and ROM
• CVS: Pulse, peripheral circulation (must do if trophic changes are present); Heart examination
• Look for signs of thyrotoxicosis/ cirrhosis/ collagen vascular disease e.g. SLE, Dermatomyositis
• Examine axillary lymph nodes
• Test sensory function of Upper Limb

1. Pin prick, cotton wool/touch according to dermatome
2. Joint sensory function, finger distal I/F joint; Thumb distal I/F joint
3. Specific sense of cortical function

If Spastic CP: note persistent adducted thumb/ pronator tone and elicit primitive reflexes

Question 2

Dermatome of UL

Answer 2

Shoulder - C5
Axilla - T1
Arm - Lateral - C5; Medial - T1
Forearm - Lateral - C6; Medial - C8
Hand thumb - C6
Mid- finger - C7
Little finger - C8

Question 3

Myotome of UL

Answer 3

Shoulder 
•  Abduction C5
•  Adduction C6-8
•  Flexion C5-8
•  Extension C5-8

Elbow
• Flexion C5-6
• Extension C7-8
• Rotation C6

Wrist
• Flexion C6-7
• Extension C6-7

Fingers
• Grip and open gripping C7-8
• Abduction T1
• Adduction T1

Question 4

Possible diagnosis when being asked to examine the Upper Limb

Answer 4

1. Neurological lesion
2. Musculoskeletal abnormality
3. Skin lesion
   - dermatological diagnosis
   - Collagen vascular disease
4. Asymmetry - size and length
5. Systemic disease - thyrotoxicosis; liver disease

Question 5

Claw hand

Answer 5

1. Unilateral
   • Examine UL neurologically (Abnormal sensory & motor function) –> Peripheral neuropathy

2. Bilateral 
•  Dysmorphic face --> MPS
•  Normal face --> 
•  •  Examine UL neurologically
•  •  Spine 
•  •  LL neurologically for UMN sign