Peripheral Limb Exam

Question 1

What position should a patient be in for a peripheral limb exam?

Answer 1

Supine, reclined at 45 degrees

Question 2

What level of exposure should a patient be in for a peripheral limb exam?

Answer 2

Limbs fully exposed for wasting inspection

Question 3

What should the end of the bed exam reveal in a peripheral limb exam? (3)

Answer 3

• Facial muscle wasting
• Signs of other neurological conditions
• Signs around bed e.g walking aids/wheelchair/orthoses

Question 4

What are the steps of an upper limb peripheral limb exam? (10)

Answer 4

• End of bed
• General inspection
• Gait
• Pronator drift
• Tone
• Power
• Reflexes
• Co-ordination
• Sensation (light touch/pain + pin prick/vibration/temperature/joint position)

Question 5

What is assessed for in gait?

Answer 5

• Normal walk
• Heel-toe walk
• Romberg’s test

Question 6

What is Romberg’s test? (3)

Answer 6

• Patient upright
• Close eyes
• Checks sensory ataxia

Question 7

What is pronator drift? (3)

Answer 7

• Ask patient to hold arms palms facing downwards
• Eyes closed
• “Holding a tray”

Question 8

What can be seen

Answer 8

• Scars
• Wasting/bulk of muscles
• Involuntary movements – dystonia / chorea / myoclonus
• Fasciculations
• Tremor – Parkinson’s disease / essential tremor
  Don’t forget to look at the face for clues e.g hypomimia (lack of expression) in Parkinson’s disease, ptosis and frontal balding in myotonic dystrophy, ptosis and ophthalmoplegia in myasthenia gravis
• Face
• Asymmetry
• ## Deformities e.g clawing/pes cavus