Neurological examination of the upper limb Flashcards
What is the order of examination for upper limb?
- inspection
- motor system assessment
- sensory system assessment (stereognosis and proprioception)
- co-ordination and rapid alternating movements
- reflexes (biceps and triceps)
What do you need to comment on during inspection?
- symmetry
- size
- involuntary movements
- atrophy or hypertrophy
- flacidity/spasticity
Where do you start palpation of the upper limbs?
start at shoulders, work down to hands
What do you need to comment on during motor system assessment?
- muscle tone (flaccidity and or spasticity)
- muscle strength
- size of muscles
- pain or tenderness
What is involved in motor system assessment?
- palpate shoulders to hands
- passively move the limb through flexion, extension, abduction, adduction
- active muscle strength tested by applying full resistance
What is involved in the sensory system assessment?
- sharp and dull
- stereogenesis (tell you what something is by touch alone)
- proprioception (move pt. thumb around with their eyes closed while they tell you which direction its going)
Which tracts are involved in the sharp/dull test?
the anterolateral spinothalamic tracts
Which tracts are involved in stereogenesis and proprioception?
posterior column tracts
Which dermatomes are tested in the dull/sharp test?
C2-T2
What is involved in the co-ordination and rapid alternating movements tests?
- pt. to touch nose then practitioners finger (practitioner to move finger around), note the movement is smooth and accurate
- pat the knees with both hands, flip hands
where do you test the reflexes for the UL?
Biceps - spinal segment C5-C6, normal response sees flexion of the forearm
Triceps - spinal segment C7-C8, normal response sees extension of the forearm
