The Upper Limb

Question 1

What do you look for on General Inspection at the end of the bed?

Answer 1

Walking aids, body habitus, well/unwell, obvious tremor/involuntary movement, posturing

Question 2

What do you look for on inspection of the upper limb?

Answer 2

Wasting, fasciculation, tremor, myoclonic jerks, deformity & posture

PRONATOR DRIFT!!!

SWIFT

Scars
Wasting
Involuntary movements
fasciculations
Tremors

Question 3

What do you do to test the motor nerve supply?

Answer 3

Tone, Power, Reflexes

Question 4

What reflexes do you test in the upper limb?

Answer 4

Bicep Jerk
Supinator Jerk
Tricep Jerk

Question 5

What does the Bicep Jerk examine the function of?

Answer 5

The C5 and C6 Reflex Arc

Question 6

What nerve carries the supinator reflex?

Answer 6

The radial nerve (C5, C6)

Question 7

What nerves carries the tricep jerk?

Answer 7

C6 + C7 (sensory) and the radial nerve (motor)

Question 8

What is the test for coordination?

Answer 8

Finger-to-nose test

Rapid Accurate Movement (Hand pat)

Question 9

What are the tests for Sensation?

Answer 9

Cotton wool (Soft Touch), Neurotip (Pain), Vibration, temperature, proprioception

Question 10

What is the scale for muscle power?

Answer 10

The UK MRC scale

0 - No muscle contraction
1 - Flicker of contraction but no movement
2 - Joint movement when gravity eliminated (ie side to side on bed)
3 - Movement against gravity but not against resistance
4 - Movement against resistance but weaker than expected
5 - Normal power

Question 11

How would you complete the exam?

Answer 11

Lower limb neurological examination
Cranial Nerve examination
MRI/CT cervical spine