Upper Limb

Question 1

Inspection

Answer 1

S
W
I
F - tapping over wasted muscle may elicit
T - fast or slow? fine or coarse? At rest, on posture, finger nose testing
Pronator drift

Typical UMN problems cause ADduction of shoulder, flexed elbow, flexed wrist.

Question 2

Tone

Answer 2

Hold hand, support at elbow
Keeping talking will help keep arm relaxed

Rotate forearm
Flex and extend wrist and elbow

VARY SPEED AND DIRECTION OF MOVEMENTS

Question 3

Power

Answer 3

Shoulder abduction (C5)
Elbow flexion (C5/6) and extension (C7)
Wrist flexion (C7) and extension (C7)
Finger extension (C7), flexion (C8) and abduction 
(T1)
Thumb abduction (T1)

Always get the patient to activate the muscle group before applying resistance. GRADE POWER!

Question 4

Sensation

Answer 4

Pin prick (superficial pain) - dermatomal pattern, compare one arm with the other

Vibration (128 Hz) - test on sternum and then on bony prominences asking patient to say when they feel the vibration end

Question 5

Reflexes

Answer 5

Biceps (finger on tendon) - C5
Supinator (finger on tendon) - C5/C6
Tricep (tendon directly) - C7

Grade reflex - reduced, normal or brisk?

Question 6

Co-ordination

Answer 6

Finger nose testing - cerebellar lesion may cause finger to undershoot or overshoot

Question 7

Finish

Answer 7

Thank patient and wash hands

I would also like to….

Question 8

General inspection

Answer 8

Pain, slings etc