Upper Limb Flashcards
What should you look for on inspection of the upper limb?
Scars Wasting Involuntary movements Fasciculations Tremor
List 4 types of involuntary movement that may be seen on inspection of the upper limb
Pseudoathetosis: writing movements due to failure of proprioception
Chorea: semi-directed, irregular movements (Huntington’s)
Myoclonus: brief, irregular twitching of muscle/ group
Tardive dyskinesia: repetitive e.g. protrusion of tongue, lip-smacking
List 3 facial signs that may be seen on inspection of the upper limb
Hypomimia: reduced facial exp. (Huntington’s)
Ptosis + frontal balding (Myotonic dystrophy)
Opthamoplegia: weakness of >,1 extra ocular muscle (MS)
What does pronator drift indicate?
Contralateral pyramidal tract lesion
in UMN lesion supinators of forearm are weaker than pronators
What is indicated by spasticity? Give an example of a condition causing this
Pyramidal tract lesions
Stroke
Why is spasticity ‘velocity dependent’? What is this also know as?
Faster you move the limb, the worse it is
Increased tone in initial movement which suddenly reduces past a certain point
Clasp knife spasticity
What is indicated by rigidity? Give an example of a condition causing this
Extrapyramidal tract lesions
Parkinsons disease
Why is rigidity ‘velocity independent’?
Feels the same if you move the limb rapidly or slowly
What is cogwheel rigidity? What is it associated with?
Tremor superimposed on hypertonia
Results in intermittent increases in tone during movement Parkinson’s
What is lead pipe rigidity? What is it associated with?
Uniformly increased tone throughout movement
Neuroleptic malignant syndrome
Which myotome(s) and muscle(s) are assessed in abduction of the shoulder?
C5 (Axillary)
Deltoid
Which myotome(s) and muscle(s) are assessed in adduction of the shoulder?
C6/7 (Thoracodorsal)
Teres major, Latissimus dorsi + Pectoralis major
Which myotome(s) and muscle(s) are assessed in flexion of the elbow?
C5/6 (Musculocutaneous + Radial)
Biceps brachii, coracobrachialis + brachialis
Which myotome(s) and muscle(s) are assessed in extension of the elbow?
C7 (Radial)
Triceps brachii
Which myotome(s) and muscle(s) are assessed in flexion of the wrist?
C6/7 (median)
Flexors of wrist
Which myotome(s) and muscle(s) are assessed in extension of the elbow?
C6 (Radial)
Extensors of wrist
Which myotome(s) and muscle(s) are assessed in extension of the fingers?
C7 (Radial)
Extensor digitorum
Which myotome(s) and muscle(s) are assessed in abduction of the fingers?
T1 (Ulnar)
First dorsal interosseous + Abductor digiti minimi
Which myotome(s) and muscle(s) are assessed in abduction of the thumb?
T1 (Median)
Abductor pollicis brevis
Describe the pattern of weakness in UMN lesions
Pyramidal pattern
Disproportionately affects upper limb extensors + lower limb flexors
Describe the pattern of weakness in LMN lesions
Focal pattern
Only muscles directly innervated by damaged neurones affected
Which 4 movements can be used for assessing power in the shoulders, elbows, wrists and fingers?
Chicken wings: Stop me from pushing them down, stop me from pulling them up
Boxer: Push against me
Stop the traffic: Stop me from straightening them, stop me from pulling them up
Zombie: Stop me from pushing them down
What nerves are tested in the biceps reflex?
C5
C6
What nerves are tested in the triceps reflex?
C7
What nerves are tested in the supinator reflex?
C5
C6
What 2 features may be seen on testing coordination of a patient withipsilateralcerebellar pathology?
Dysmetria
Intention tremor
What is Dysmetria?
lack of coordination of movement- patient missing the target by over/ undershooting
What is Intention tremor?
broad, coarse, low-frequency tremor that develops as a limb reaches the endpoint of a deliberate movement. Apparent as the patient’s finger approaches yours.
What is an action tremor?
Occurs throughout movement
