UL Neuro

Question 1

Spinal level - biceps + brachioradialus reflexes

Answer 1

C5, C6

Question 2

Spinal level - triceps jerk

Answer 2

C7, C8

Question 3

Causes of nerve palsies

Answer 3

Transection or compression - trauma, neoplastic mass
Small vessel ischaemia
Post RTx
Inflammation of nerve roots - HSV, Zoster, EBV

Question 4

Ulna nerve
Sensory
Motor
Spinal level

Answer 4

C8-T1
Little finger and half of ring finger
Ulna claw - claw hand - inability to extend fingers
Peace sign

Question 5

Median nerve
Sensory
Motor
Spinal level

Answer 5

C6- T1
Palm and proximal pointer and rude finger
Ape hand - inability to oppose thumb
OK sign

Question 6

Radial nerve
Sensory
Motor
Spinal level

Answer 6

C5-C8

Thumb + most of dorsum of hand, proximal half pointer and rude finger

Wrist drop - inability to extend wrist

Question 7

What nerve

Answer 7

Green - ulna
Pink - median
Blue - radial

Question 8

Brachial plexopathies - Klumpke’s

Answer 8

“True claw”
C8-T1
All hand muscles involved

Question 9

Brachial plexopathies - Erbs

Answer 9

C5, C6
“Waiters tip”
Lose shoulder, elbow and wrist flexion
Most commonly shoulder dystocia

Question 10

Pronator drift
Instruction
Interpret

Answer 10

Arms out with palms up, eyes closed
Positive - pronates arm, slight weakness in this arm, CST dysfunction in contra lateral hemisphere

Drifts upward? Lesion ipsilateral cerebellum or ipsi dorsal column

Question 11

NHMRC grading of power 0-5

Answer 11

0 - complete paralysis
1 - flicker of contraction
2 - movement of gravity removed
3 - movement possible against gravity, but not resistance
4 - movement possible against gravity, some resistance
5 - normal

Question 12

Functional assessment for UL

Answer 12

Feeding - jar, cup, utensils
Hygiene - teeth, hair, toileting
Dressing - shirt on/ off, buttons, zippers
Work - grip beads, thread button, turn key, scissors

Question 13

UL exam approach

Answer 13

1. IHUGVIDEP
   - resting posture
   - contractures
   - AFOs, wrist splints
   Look at back and neck!!
2. Pronator drift
3. Plapation - muscle bulk
4. Tone - wrists and elbow
5. Power
   - corticospinal tract
   - brain contralteral side
   - spine ipsi
6. Reflexes
7. Coordination
8. Sensation
   - dorsal column: fine touch (contralateral brain, spine ipsi)
   - spinothalamic: pain or temp (contralteral in brain + spinal cord lesion coz crosses over in cord)
9. Function

Question 14

Dorsal column - how to test
Where for brain or spine lesion

Answer 14

• dorsal column: fine touch, vibration, 2 point discrimination (contralateral brain, spine ipsi)

Question 15

Spinothalamic
How to test
Where brain and spine lesion

Answer 15

• spinothalamic: pain or temp (contralteral in brain + spinal cord lesion coz crosses over in cord)