Neuro - Upper Limb Flashcards
What do you look for on general inspection?
Abnormal posture
SWIFT - scars, wasting of muscle, involuntary movements, fasciculations, tremor
What do you look for when the patient raises their arms?
Ask them to close their eyes
Turn arms from dorsal to palmar aspect
Assess for pronator drift –> UMN pathology on contralateral side
How do you assess tone?
Let arms go floppy
Assess from all joints
Assess for cog-wheel rigidity in wrists (Parkinson’s)
Assess for increased tone (UMN lesions eg stroke)
How do you assess power?
Shoulder abduction tests C5 (“stop me from pushing them down”)
Shoulder adduction tests C6/7 (“stop me from pulling them up”)
Elbow flexion tests C5/6 (pulling down)
Elbow extension tests C7 (pushing up)
Wrist extension tests C6 (push down)
Wrist flexion tests C6/7 (pull up)
How do you assess power in the fingers?
Finger extension tests C7 (push down)
Finger abduction tests first dorsal interosseous and abductor digiti minimi (push together)
Thumb abduction tests C8/T1, thenar eminence (push down)
What reflexes should you test?
Biceps (C5/6) - crease of elbow
Triceps (C6/7) - before elbow
Supinator (C5/6) - before wrist
How do you assess sensation?
C5-T1 on right and left with eyes closed
Cotton wool = light touch Neuro tip = fine touch
How do you assess vibration?
Tuning fork
1. Place on distal bony prominence eg DIP joint
2. Ask patient to say when vibration has stopped
Assess on more proximal joint if unable to feel
How do you assess proprioception?
- Patient closes eyes
2. Ask if distal thumb is pointing up or down
How do you assess coordination? (I)
Touch finger to nose and then your finger and repeat with finger moving
Observe for intention tremor and past-pointing (cerebellar disease)
Do with both fingers
How do you assess coordination? (II)
Rapid alternating movement test (turn hand over and back repeatedly)
Assess for adiadochokynesia (Parkinson’s)
What order should you test things in a neuro exam?
Tone Power Reflexes Sensation Coordination
