Neurological System (Upper limb)

Question 1

In the upper limb which muscle group tone should be assessed?

Answer 1

Shoulder
Wrist
Elbow

Question 2

How is tone assessed for the shoulder?

Answer 2

Circumduction

Question 3

How is tone assessed at the elbow joint?

Answer 3

Flexion and extension

Question 4

How is tone assessed in the wrist?

Answer 4

Circumduction

Question 5

What abnormalities are detected when assessing the tone at each joint?

Answer 5

Spasticity
Rigidity
Cogwheeling
Hypotonia

Question 6

Hypotonia is associated with which type of motor neurone lesion?

Answer 6

Lower motor neurone

Question 7

Spasticity is associated with which type of tract lesion?

Answer 7

Pyramidal tract

Question 8

Pyramidal tract lesions are associated with what type of abnormality?

Answer 8

Spasticity

Question 9

What does hypertonia arise with an upper motor neurone lesion?

Answer 9

Upper motor neurones exhibit an inhibitory effect on the lower motor neurones, thus if this inhibition is lost, muscle tone is exaggerated

Question 10

What abnormality is associated with extrapyramidal tract lesions?

Answer 10

Parkinson’s disease

Question 11

Which myotome is associated with shoulder abduction?

Answer 11

C5

Question 12

Which muscle group is associated with shoulder abduction?

Answer 12

Deltoids

Question 13

How is the power of shoulder abduction assessed?

Answer 13

Flex elbows, and apply a downwards force, to which resistance is assessed
Ensure that the shoulder joint is isolated

Question 14

When assessing shoulder adduction which myotome is being assessed?

Answer 14

C6/C7

Question 15

Which muscles are associated with shoulder adduction?

Answer 15

Teres major
Latissimus dorsi
Pectoralis major

Question 16

How is the power of shoulder adduction assessed?

Answer 16

Bring elbows closer to the body and apply upwards resistance.

Question 17

Which myotome is associated with elbow flexion?

Answer 17

C5-C6

Question 18

Which muscle group is associated with bicep flexion?

Answer 18

Biceps brachii

Question 19

How should elbow flexion be assessed (power)?

Answer 19

Apply resistance by pushing forearm away.

Question 20

Which muscle is concerned with elbow extension?

Answer 20

Triceps brachii

Question 21

Which myotome is concerned with elbow extension?

Answer 21

C7

Question 22

How is the power of elbow extension assessed?

Answer 22

Apply resistance by applying a pushing force

Question 23

Which myotome is concerned with wrist flexion?

Answer 23

C6/C7

Question 24

Which scale is used to assess power?

Answer 24

MRC muscle power scale

Question 25

What does a score of 0 represent on the MRC muscle power scale?

Answer 25

No movement

Question 26

A score of 1 on the MRC scale represents what?

Answer 26

Barest flicker of movement of the muscle, though not enough to move the structure to which it’s attached

Question 27

A score of 2 on the MRC scale represents what?

Answer 27

Voluntary movement which is not sufficient to overcome the force of gravity

Question 28

What score is associated with voluntary movement capable of overcoming gravity but not applied resistance?

Answer 28

3

Question 29

A score of 4 on the MRC scale represents what?

Answer 29

Voluntary movement capable of overcoming resistance

Question 30

What nerve roots are associated with the biceps reflex?

Answer 30

C5 | C6

Question 31

How is the biceps reflex conducted?

Answer 31

Locate the biceps tendon, residing on the medial aspect of the antecubital fossa, place thumb of non-dominant hand over the tendon and tap your thumb with the tendon hammer

Question 32

Which nerve roots are associated with the triceps reflex?

Answer 32

C7 | C8

Question 33

Which nerve roots are associated with the supinator reflex?

Answer 33

C6

Question 34

How is the triceps reflex elicited?

Answer 34

Triceps tendon relaxed, rest the patients elbow in 90 degree flexion on their lap, locate the triceps tendon, found superior to the olecranon process of the ulna

Question 35

Where is the triceps tendon located?

Answer 35

Superior to the olecranon process of the ulna

Question 36

Which tendon is associated with the supinator reflex?

Answer 36

Brachoradialis tendon

Question 37

Where is the supinator reflex elicited?

Answer 37

Locate the brachioradialis tendon which can be found on the posterolateral aspect of the wrist - 4 inches away proximal to the base of the thumb. Position two fingers over the tendon, tap your fingers with the tendon hammer.

Question 38

Areflexia is associated with which type of lesion?

Answer 38

Lower motor neurone lesion

Question 39

Hyperreflexia is associated with which type of lesion?

Answer 39

Upper motor neurone lesion

Question 40

The C5 dermatome is associated with which aspect of the upper arm?

Answer 40

Lateral aspect of the lower edge of the deltoid muscle (regimental badge)

Question 41

The regimental badge is associated with which dermatome?

Answer 41

C5

Question 42

The C6 dermatome is associated with which part of the upper limb?

Answer 42

The palmar side of the thumb

Question 43

The palmar side of the the thumb is associated with which dermatome?

Answer 43

C6

Question 44

The C7 dermatome is associated with which aspect of the upper limb?

Answer 44

The palmar side of the middle finger

Question 45

Which dermatome is implicated in the palmar side of the middle finger?

Answer 45

C7

Question 46

The C8 dermatome is associated with which aspect of the upper limb?

Answer 46

Palmar side of the little finger

Question 47

The palmar side of the little finger is associated with which dermatome?

Answer 47

C8

Question 48

Which dermatome is associated with the medial aspect of the antecubital fossa?

Answer 48

T1

Question 49

The T1 dermatome is associated with which aspect of the upper limb?

Answer 49

The medial aspect antecubital fossa proximal to the medial epicondyle

Question 50

The axilla is associated with which dermatome?

Answer 50

T2