Neuro - upper limb

Question 1

Order

Answer 1

Inspection
Pronator drift - hands supinated, elbows extended, eyes closed
Tone
Power
Reflexes
Co-ordination
Sensation

Question 2

Inspection

Answer 2

Muscle wasting
Fasciculations
Tremor
Scars

Question 3

Tone

Answer 3

Ask to relax arms, let me take the weight
Compare sides!

• shoulder - rotate, up down
• elbow - flex extend
• wrist - rotate

Increased -> UMN lesion
Decreased -> LMN lesion

Question 4

Power

Answer 4

Isolate one joint at a time
Compare sides!

• shoulder - chicken wings, up down
• elbow - boxer, in out
• wrist - straight out in front, up down
• fingers - splayed, push in out (with equivalent finger)
• thumb - up down

Grading:
5 = normal
4 = reduced against resistance
3 = overcomes gravity
2 = cannot overcome gravity
1 = muscle flicker
0 = no muscle contraction

Question 5

Reflexes

Answer 5

Supported, relaxed limbs
Compare both sides!

• biceps - in elbow pit
• triceps - behind elbow
• supinator - top of wrist

Can reinforce with clench teeth at same time

Question 6

Co-ordination

Answer 6

Finger-nose - must be at extension of arm
(past pointing is cerebellar problem)

Dysdiadochokinesis

Question 7

Sensation

Answer 7

Compare both sides!
Eyes shut, say when feel
Dermatomal distribution

• fine touch - cotton wool
• sharp touch - neuro tip
• vibration - tuning fork to distal joint, then up if don’t feel
• proprioception