Neurology - Upper Limb

Question 0

UMN lesion; tone, power, reflexes, plantars, coordination, other features

Answer 0

Tone: spastic
Power: reduced
Reflexes: brisk
Plantars: up
Coordination: reduced
Other features: clonus

Question 1

LMN lesion; tone, power, reflexes, plantars, coordination, other features

Answer 1

Tone: reduced
Power: reduced
Reflexes: reduced
Plantars: down
Coordination: normal
Other features: wasting fasiculations

Question 2

Extrapyramidal lesion; tone, power, reflexes, plantars, coordination, other features

Answer 2

Tone: rigid
Power: normal
Reflexes: normal
Plantars: down
Coordination: reduced
Other features: TRAP

Question 3

Cerebellar lesion; tone, power, reflexes, plantars, coordination, other features

Answer 3

Tone: reduced
Power: normal
Reflexes: normal
Plantars: down
Coordination: very reduced
Other features: VANISHED

Question 4

Pain and temperature pathway and pathology Ddx

Answer 4

Pathway: spinothalamic
Ddx: syringomyelia

Question 5

Vibration, proprioception and fine touch pathway and pathology Ddx

Answer 5

Pathway: dorsal column
Ddx: tabes dorsalis, b12/folate deficiency (subacute combined degeneration of the cord - SCDC)

Question 6

Syringomyelia - pathophysiology, signs

Answer 6

Pathophysiology: expansion of central canal due to CSF blockage
Signs:
1. Loss of pain and temperature sensation (arms, shoulder and upper body - ‘Cape like’)
2. LMN signs in upper limbs
3. Spastic paraparesis in lower limbs
4. Dorsal column sensation affected if severe
5. Syringobulbia if syrinx extends into brainstem

Question 7

Erb’s palsy signs

Answer 7

Injury to C5-7 - shoulder dystocia during birth

1. Sensory loss down lateral arm
2. ‘Waiter’s tip’ position (shoulder adducted, arm internally rotated, forearm pronated)

Question 8

Klumpke’s palsy

Answer 8

Injury to C8-T1 - excessive arm traction during birth

1. Sensory loss in medial forearm and hand
2. Complete claw hand
3. Wasting of small muscles in hand
4. Horner’s syndrome may coexist

Question 9

1. Sensory loss down lateral arm

2. ‘Waiter’s tip’ position (shoulder adducted, arm internally rotated, forearm pronated)

Answer 9

Erb’s palsy

Question 10

1. Sensory loss in medial forearm and hand
2. Complete claw hand
3. Wasting of small muscles in hand

Answer 10

Klumpke’s palsy

Question 11

Tone: reduced
Power: reduced
Reflexes: reduced
Plantars: down
Coordination: normal
Other features: wasting, fasiculations

Answer 11

LMN lesion

Question 12

Tone: spastic
Power: reduced
Reflexes: brisk
Plantars: up
Coordination: reduced
Other features: clonus

Answer 12

UMN lesion

Question 13

Tone: rigid
Power: normal
Reflexes: normal
Plantars: down
Coordination: reduced
Other features: TRAP

Answer 13

Extrapyramidal lesion

Question 14

Tone: reduced
Power: normal
Reflexes: normal
Plantars: down
Coordination: very reduced
Other features: VANISHED

Answer 14

Cerebellar lesion