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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
What myotome, nerve and muscle are you assessing for the wrist flexion?
Myotome → C6/C7 Nerve → median nerve Muscle → flexors of wrist
26
Instructions for patient when assessing for the wrist flexion?
* Hold your arms out in front of you, making a fist.* * Point your wrist downwards and don't let me pull them up*
26
Instructions for patient when assessing for the wrist flexion?
* Hold your arms out in front of you, making a fist.* * Point your wrist downwardsa nd don't let me pull them up*
27
What myotome, nerve and muscle are you assessing for the wrist extension?
Myotome → C6 Nerve → radial nerve Muscles → extensors of wrist
28
Instructions for patient when assessing for the wrist extension?
* 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
What movements of the finger joints are you assessing in ‘power’?
1. Flexion 2. Extension 3. Abduction 4. Adduction
30
Instructions for patient when assessing for the finger flexion?
*Hold your fingers out straight and don’t let me push them up*
31
Instructions for patient when assessing for the finger extension?
*Hold your fingers out straight and don’t let me push them down*
32
What myotome, nerve and muscle are you assessing for finger extension?
Myotome → C7 Nerve → radial nerve Muscles → extensor digitorum
33
What myotome, nerve and muscle are you assessing for finger abduction?
Myotome → T1 Nerve → Ulnar nerve Muscle → First dorsal interosseous (FDI), abductor digiti minimi (ADM)
34
Which 2 fingers should you assess for abduction?
Index and little finger
35
What movements of the thumb joints are you assessing in ‘power’?
1. Abduction 2. Adduction
36
What myotome, nerve and muscle are you assessing for fthumbnger abduction?
Myotome → T1 Nerve → median nerve Muscle → adductor pollicis brevis
37
Instructions for patient when assessing for the thumb abduction?
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
Describe a pyramidal pattern of weakness
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
What 3 reflexes are assessed in an upper limb neuro exam?
1. Biceps reflex 2. Supinator (brachioradialis reflex) 3. Triceps reflex
40
Which nerve roots are being assessed in the biceps reflex?
C5/C6
41
Describe the steps of assessing the biceps reflex
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
Which nerve roots are being assessed in the supinator/brachioradialis reflex?
C5/C6
43
Describe the steps of assessing the brachioradialis reflex
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
What is the normal response of the biceps reflex?
**contraction of the biceps muscle** and associated **flexion of the elbow**
45
What is the normal response of the supinator reflex?
**contraction of the brachioradialis** muscle and associated flexion, pronation or supination of the **forearm at the elbow**
46
What nerve roots does the triceps reflex assess?
C6/C7
47
Describe the steps of assessing the triceps reflex
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
What is the normal response of the triceps reflex?
Contraction of the triceps muscle
49
What 2 tests are involved in assessing coordination?
1. Finger to nose test 2. Dysdiadochokinesia
50
In patients with **_cerebellar pathology_**, what signs may they exhibit in the finger to nose test?
Dysmetria Intention tremor
51
How may a patient exhibit dysmetria in the finger to nose test?
patient missing target by over/undershooting
52
Define dysmetria
Lack of coordination of movement
53
What is an intention tremor?
A broad, coarse, low frequency tremor that develops as a limb reaches the **endpoint** of a deliberate movement
54
How may a patient exhibit an intention tremor in the finger to nose test?
tremor becomes apparent as patient’s finger approaches yours
55
What can an intention tremor often be mistook for?
Action tremor → this occurs throughout the movement
56
What would dysmetria & intention tremor be indicative of in the finger to nose test?
**_ipsilateral cerebellar pathology_** (but coordination can also be affected by weakness or sensory disturbance)
57
Define dysdiadochokinesia
A term that describes the inability to perform rapid, alternating movements
58
What is dysdiadochokinesia a feature of?
ipsilateral cerebellar pathology
59
How may patients with **cerebellar ataxia** present during the assessment of ‘dysdiadochokinesia'?
Patients with cerebellar ataxia may struggle to carry out this task; movements appear **slow** and **irregular**
60
Dermatomes of the upper limb
* 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
Which joint is used in the assessment of vibration sensation?
**interphalangeal joint of the patient’s thumb**
62
What sensory deficits would peripheral neuropathy typically present with?
Typically causes **symmetrical sensory deficits** in a ‘glove and stocking’ distribution in the peripheral limbs.
63
Most common causes of peripheral neuropathy?
Diabetes mellitus Chronic alcohol excess
64
What sensory deficits would mononeuropathies result in?
Result in a **localised sensory disturbance** in the area supplied by the damaged nerve e.g. axillary nerve dysfunction
65
Define radiculopathy
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
What sensory deficits would thalamic lesions (e.g. stroke) result in?
**_Contralateral_** sensory loss
67
How do myopathies (e.g. myotonic dystrophy) typically present?
Often involve **symmetrical proximal muscle weakness**
68
Define glove and stocking neuropathy
A characteristic pattern of numbness in which the distal portions of the nerves are first affected.
69
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Yr 3 - Clinical Examinations (11 decks)

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