Peripheral Nerve : Upper Limb (Exam)

Question 1

How would you explain and gain consent for an upper limb PNS exam?

Answer 1

• I’ve been asked to examine the nerves that supply your shoulders and arms.
• this will involve testing the power, co-ordination and sensation.
• your shoulders and arms will have to be exposed.
• the examiner will act as a chaperone.
• Is this ok?

-are you in any pain.

Question 2

What is the general layout of an upper limb PNS exam?

Answer 2

1) WIPE
2) are you in any pain
3) Gen inspction
4) Tone (“shake hand”)
5) Power - L/R handed? (chicken, boxer, biker)
6) co-ordination (finger-nose, dysdiadokokinesis, rebound)
7) Reflexes
8) Sensation
9) Proprioception
10) Vibration

Question 3

What do you look for on gen inspection in an upper limb PNS?

Answer 3

Mobility aids, slings or splints.

SWIFT:

• symmetry
• wasting
• involantary movements
• Fasiculations
• Tremors

Question 4

How do you examine tone in an upper limb PNS?

Answer 4

1) hold patient’s hand as if shaking it.
2) support arm at elbow with other hand.
3) flex and extend wrist
4) flex and extend elbow
5) pronate + supinate forearm
6) rotate shoulder

Question 5

How do we test power in an upper limb PNS exam?

Answer 5

(chicken, boxer, biker)

1) ask patient if they are left or right handed.
2) Pronator Drift.
3) shoulder abduction , adduction
4) Elbow flexion, extension
5) wrist flexion, extension
6) Finger adduction, abduction, flexion, extensio
7) thumb adduction, abduction

Question 6

How do we test co-ordination in an upper limb pns exam?

Answer 6

1) Finger to nose test
2) Dysdiadokinesis
3) Rebound phenomena

Question 7

What reflexes do we test and what are the nerve roots being tested?

Answer 7

Supinator (C5/C6)
Biceps (C5/C6)
Triceps (C6/C7)

Question 8

How do we test sensation and what are the dermatomes being tested?

Answer 8

- soft vs sharp sensation
Dermatomes:
- C4 (clavicle and part of shoulder)
-C5 (lateral side of arm)
-C6 (lateral side of arm and thumb)
-C7 (middle finger)
-C8 ( ring finger and little finger)
-T1 (medial side of forearm)
-T2 (medial side of arm)
-T3 (armpit)

Question 9

How do we test proprioception in an upper limb PNS exam?

Answer 9

• move DIP joint of index finger with pt eyes closed

Question 10

How do we test vibration sense in a upper limb PNS exam?

Answer 10

Use a 128hz tuning fork on DIP of index finger. Identify vibration start and stop.

Question 11

How is pronator drift testes and what causes a pronator drift?

Answer 11

Pronator drift:

• pt puts arms out in front of them, palms facing up and eyes closed.
• in an upper motor neurone lesion the affected arm will pronate and fall
• this a positive pronator drift sign - this is abnormal

Question 12

The finger to nose test is used to test co-ordination in an UL PNS exam - what are you looking for?

Answer 12

• past pointing
• intention tremor

Suggest cerebellar lesion

Question 13

What is dysdiadokokinesis?

Answer 13

When a patient does the patty cake movement and it is erratic in force and rhythm this is dysdiadokokinesis - it is present in Multiple sclerosis

Question 14

In rebound phenomena test if the antagonist muscles do not work to stop the patient from hitting themselves what is this a sign of?

Answer 14

• cerebellar disease