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Yr 3 - Clinical Examinations > Peripheral Nerve Exam - Upper Limb > Flashcards

Peripheral Nerve Exam - Upper Limb Flashcards

1
Q

What 3 joints are assessed when assessing the ‘tone’ of the upper limb?

A
  1. Shoulder
  2. Elbow
  3. Wrist
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2
Q

What 3 movements are assessed when assessing the ‘tone’ of the upper limb?

A
  1. Shoulder → circumduction
  2. Elbow → flexion & extension
  3. Wrist → circumduction
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3
Q

How should you hold the patient’s arm when assessing tone?

A

Support patient’s arm by holding their hand and elbow as you move their arm through the movements.

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4
Q

Is spasticity or rigidity associated with pyramidal tract lesions?

A

Spasticity is associated with pyramidal tract lesions (e.g. stroke)

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5
Q

Is a stroke an example of a pyramidal or extrapyramidal tract lesion?

A

Pyramidal

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6
Q

Is spasticity or rigidity associated with extrapyramidal tract lesions?

A

Rigidity (think Parkinson’s)

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7
Q

Is Parkinson’s disease an example of a pyramidal or extrapyramidal tract lesion?

A

Extrapyramidal

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8
Q

What should be assessed during the ‘power’ aspect before individudal muscle group testing?

A

Pronator drift

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9
Q

What is the purpose of assessing pronator drift?

A

Useful way of assessing for mild upper limb weakness and spasticity.

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10
Q

How do you assess for pronator drift?

A
  1. Ask patient to hold their arms out in front of them with palms facing upwards
  2. Observe for signs of pronation for 20-30 seconds
  3. If no pronation occurs – ask patient to close their eyes and observe once again for pronation (this typically accentuates the effect due to reliance of proprioception alone)
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11
Q

If the forearm pronates (with or without downward movement), the patient is considered to have pronator drift on that side. What does the presence of a pronator drift indicate?

A

Indicates a contralateral pyramidal tract lesion (UMN)

Pyramidal → associated with spasticity

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12
Q

Is spasticity or rigidity velocity dependent?

A

Spasticity

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13
Q

What 5 joints are you assessing when testing muscle power?

A
  1. Shoulder
  2. Elbow
  3. Wrist
  4. Fingers
  5. Thumb
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14
Q

What movements of the shoulder joint are you assessing in ‘power’?

A
  1. Abduction
  2. Adduction
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15
Q

What myotome, nerve and muscle are you assessing for the shoulder abduction?

A

Myotome → C5

Nerve → axillary nerve

Muscle → deltoid (primary) and other shoulder abductors

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16
Q

Instructions for patient when assessing for the shoulder abduction?

A
  • Bend your elbows and bring your arms out to the sides like a chicken*
  • Don’t let me push your shoulders down*
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17
Q

What myotome, nerve and muscle are you assessing for the shoulder adduction?

A

Myotome → C6/C7

Nerve → thoracodorsal nerve

Muscles → teres major, latissimus dorsi, pectoralis major

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18
Q

Instructions for patient when assessing for the shoulder adduction?

A
  • Now bring your elbows a little closer to your sides*
  • Don’t let me pull your arms away from your sides*
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19
Q

What movements of the elbow joint are you assessing in ‘power’?

A
  1. Flexion
  2. Extension
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20
Q

What myotome, nerve and muscle are you assessing for the elbow flexion?

A

Myotome → C5/C6

Nerve → musculocutaneous and radial nerve

Muscles → biceps brachii, coracobrachialis and brachialis

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21
Q

Instructions for patient when assessing for the elbow flexion?

A

‘Put your hands up like a boxer’

Stop me from pulling them towards me

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22
Q

What myotome, nerve and muscle are you assessing for the elbow extension?

A

Myotome → C7

Nerve → radial nerve

Muscle → triceps brachii

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23
Q

Instructions for patient when assessing for the elbow extension?

A

Don’t let me push your arm towards you’

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24
Q

What movements of the wrist joint are you assessing in ‘power’?

A
  1. Extension
  2. Flexion
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25
Q

What myotome, nerve and muscle are you assessing for the wrist flexion?

A

Myotome → C6/C7

Nerve → median nerve

Muscle → flexors of wrist

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26
Q

Instructions for patient when assessing for the wrist flexion?

A
  • Hold your arms out in front of you, making a fist.*
  • Point your wrist downwards and don’t let me pull them up*
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26
Q

Instructions for patient when assessing for the wrist flexion?

A
  • Hold your arms out in front of you, making a fist.*
  • Point your wrist downwardsa nd don’t let me pull them up*
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27
Q

What myotome, nerve and muscle are you assessing for the wrist extension?

A

Myotome → C6

Nerve → radial nerve

Muscles → extensors of wrist

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28
Q

Instructions for patient when assessing for the wrist extension?

A
  • Hold your arms out in front of you, with your palms facing the ground*
  • Make a fist, cock your wrists back and don’t let me pull them downwards*
29
Q

What movements of the finger joints are you assessing in ‘power’?

A
  1. Flexion
  2. Extension
  3. Abduction
  4. Adduction
30
Q

Instructions for patient when assessing for the finger flexion?

A

Hold your fingers out straight and don’t let me push them up

31
Q

Instructions for patient when assessing for the finger extension?

A

Hold your fingers out straight and don’t let me push them down

32
Q

What myotome, nerve and muscle are you assessing for finger extension?

A

Myotome → C7

Nerve → radial nerve

Muscles → extensor digitorum

33
Q

What myotome, nerve and muscle are you assessing for finger abduction?

A

Myotome → T1

Nerve → Ulnar nerve

Muscle → First dorsal interosseous (FDI), abductor digiti minimi (ADM)

34
Q

Which 2 fingers should you assess for abduction?

A

Index and little finger

35
Q

What movements of the thumb joints are you assessing in ‘power’?

A
  1. Abduction
  2. Adduction
36
Q

What myotome, nerve and muscle are you assessing for fthumbnger abduction?

A

Myotome → T1

Nerve → median nerve

Muscle → adductor pollicis brevis

37
Q

Instructions for patient when assessing for the thumb abduction?

A

Ask the patient to turn their hand over so their palm is facing upwards and point their thumb towards the ceiling. Advise them to keep it in this position whilst you apply downward resistance with your own thumb (‘Point your thumbs towards the ceiling and don’t let me push them down’).

38
Q

Describe a pyramidal pattern of weakness

A

Pyramidal weakness, that is, the weakness that preferentially spares the antigravity muscles, is considered an integral part of an UMN lesion.

I.e. extensors weaker than flexors in upper limbs, flexors weaker than extensors in lower limb.

39
Q

What 3 reflexes are assessed in an upper limb neuro exam?

A
  1. Biceps reflex
  2. Supinator (brachioradialis reflex)
  3. Triceps reflex
40
Q

Which nerve roots are being assessed in the biceps reflex?

A

C5/C6

41
Q

Describe the steps of assessing the biceps reflex

A
  1. With the patient’s arm relaxed, locate the biceps brachii tendon which is typically found at the medial aspect of the antecubital fossa
  2. Place the index finger of your non-dominant hand over the tendon and then tap your finger with the tendon hammer
  3. Observe for a contraction of the biceps muscle and associated flexion of the elbow
42
Q

Which nerve roots are being assessed in the supinator/brachioradialis reflex?

A

C5/C6

43
Q

Describe the steps of assessing the brachioradialis reflex

A
  1. Locate the brachioradialis tendon which can be found on the posterolateral aspect of the wrist approx. 4 inches proximal to the base of the thumb
  2. With 2 fingers positioned over the tendon, tap your fingers with the tendon hammer
  3. Observe for a contraction of the brachioradialis muscle and associated flexion, pronation or supination of the forearm at the elbow
44
Q

What is the normal response of the biceps reflex?

A

contraction of the biceps muscle and associated flexion of the elbow

45
Q

What is the normal response of the supinator reflex?

A

contraction of the brachioradialis muscle and associated flexion, pronation or supination of the forearm at the elbow

46
Q

What nerve roots does the triceps reflex assess?

A

C6/C7

47
Q

Describe the steps of assessing the triceps reflex

A
  1. Position the patient’s arm so that the triceps tendon is relaxed; this is commonly achieved by resting the patient’s elbow in 90-degree flexion on their lap or by supporting the patient’s forearm
  2. Locate the triceps tendon which can be found superior to the olecranon process of the ulna
  3. Tap the tendon with the tendon hammer and observe for a contraction of the triceps muscle
48
Q

What is the normal response of the triceps reflex?

A

Contraction of the triceps muscle

49
Q

What 2 tests are involved in assessing coordination?

A
  1. Finger to nose test
  2. Dysdiadochokinesia
50
Q

In patients with cerebellar pathology, what signs may they exhibit in the finger to nose test?

A

Dysmetria

Intention tremor

51
Q

How may a patient exhibit dysmetria in the finger to nose test?

A

patient missing target by over/undershooting

52
Q

Define dysmetria

A

Lack of coordination of movement

53
Q

What is an intention tremor?

A

A broad, coarse, low frequency tremor that develops as a limb reaches the endpoint of a deliberate movement

54
Q

How may a patient exhibit an intention tremor in the finger to nose test?

A

tremor becomes apparent as patient’s finger approaches yours

55
Q

What can an intention tremor often be mistook for?

A

Action tremor → this occurs throughout the movement

56
Q

What would dysmetria & intention tremor be indicative of in the finger to nose test?

A

ipsilateral cerebellar pathology

(but coordination can also be affected by weakness or sensory disturbance)

57
Q

Define dysdiadochokinesia

A

A term that describes the inability to perform rapid, alternating movements

58
Q

What is dysdiadochokinesia a feature of?

A

ipsilateral cerebellar pathology

59
Q

How may patients with cerebellar ataxia present during the assessment of ‘dysdiadochokinesia’?

A

Patients with cerebellar ataxia may struggle to carry out this task; movements appear slow and irregular

60
Q

Dermatomes of the upper limb

A
  • C5: lateral aspect of lower edge of deltoid muscle (‘regimental bade’)
  • C6: palmar side of thumb
  • C7: palmar side of middle finger
  • C8: palmar side of little finger
  • T1: medial aspect antecubital fossa, proximal to medial epicondyle of humerus
61
Q

Which joint is used in the assessment of vibration sensation?

A

interphalangeal joint of the patient’s thumb

62
Q

What sensory deficits would peripheral neuropathy typically present with?

A

Typically causes symmetrical sensory deficits in a ‘glove and stocking’ distribution in the peripheral limbs.

63
Q

Most common causes of peripheral neuropathy?

A

Diabetes mellitus

Chronic alcohol excess

64
Q

What sensory deficits would mononeuropathies result in?

A

Result in a localised sensory disturbance in the area supplied by the damaged nerve e.g. axillary nerve dysfunction

65
Q

Define radiculopathy

A

Describes a range of symptoms produced by the pinching of a nerve root in the spinal column.

Occurs due to nerve root damage (e.g. compression by a herniated intervertebral disc) resulting in sensory disturbances in the associated dermatomes

66
Q

What sensory deficits would thalamic lesions (e.g. stroke) result in?

A

Contralateral sensory loss

67
Q

How do myopathies (e.g. myotonic dystrophy) typically present?

A

Often involve symmetrical proximal muscle weakness

68
Q

Define glove and stocking neuropathy

A

A characteristic pattern of numbness in which the distal portions of the nerves are first affected.

69
Q

Rapid screen table

A

Yr 3 - Clinical Examinations (11 decks)

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