Upper Limb

Question 1

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

Answer 1

Scars
Wasting
Involuntary movements
Fasciculations
Tremor

Question 2

List 4 types of involuntary movement that may be seen on inspection of the upper limb

Answer 2

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

Question 3

List 3 facial signs that may be seen on inspection of the upper limb

Answer 3

Hypomimia: reduced facial exp. (Huntington’s)
Ptosis + frontal balding (Myotonic dystrophy)
Opthamoplegia: weakness of >,1 extra ocular muscle (MS)

Question 4

What does pronator drift indicate?

Answer 4

Contralateral pyramidal tract lesion

in UMN lesion supinators of forearm are weaker than pronators

Question 5

What is indicated by spasticity? Give an example of a condition causing this

Answer 5

Pyramidal tract lesions

Stroke

Question 6

Why is spasticity ‘velocity dependent’? What is this also know as?

Answer 6

Faster you move the limb, the worse it is
Increased tone in initial movement which suddenly reduces past a certain point
Clasp knife spasticity

Question 7

What is indicated by rigidity? Give an example of a condition causing this

Answer 7

Extrapyramidal tract lesions

Parkinsons disease

Question 8

Why is rigidity ‘velocity independent’?

Answer 8

Feels the same if you move the limb rapidly or slowly

Question 9

What is cogwheel rigidity? What is it associated with?

Answer 9

Tremor superimposed on hypertonia

Results in intermittent increases in tone during movement Parkinson’s

Question 10

What is lead pipe rigidity? What is it associated with?

Answer 10

Uniformly increased tone throughout movement

Neuroleptic malignant syndrome

Question 11

Which myotome(s) and muscle(s) are assessed in abduction of the shoulder?

Answer 11

C5 (Axillary)

Deltoid

Question 12

Which myotome(s) and muscle(s) are assessed in adduction of the shoulder?

Answer 12

C6/7 (Thoracodorsal)

Teres major, Latissimus dorsi + Pectoralis major

Question 13

Which myotome(s) and muscle(s) are assessed in flexion of the elbow?

Answer 13

C5/6 (Musculocutaneous + Radial)

Biceps brachii, coracobrachialis + brachialis

Question 14

Which myotome(s) and muscle(s) are assessed in extension of the elbow?

Answer 14

C7 (Radial)

Triceps brachii

Question 15

Which myotome(s) and muscle(s) are assessed in flexion of the wrist?

Answer 15

C6/7 (median)

Flexors of wrist

Question 16

Which myotome(s) and muscle(s) are assessed in extension of the elbow?

Answer 16

C6 (Radial)

Extensors of wrist

Question 17

Which myotome(s) and muscle(s) are assessed in extension of the fingers?

Answer 17

C7 (Radial)

Extensor digitorum

Question 18

Which myotome(s) and muscle(s) are assessed in abduction of the fingers?

Answer 18

T1 (Ulnar)

First dorsal interosseous + Abductor digiti minimi

Question 19

Which myotome(s) and muscle(s) are assessed in abduction of the thumb?

Answer 19

T1 (Median)

Abductor pollicis brevis

Question 20

Describe the pattern of weakness in UMN lesions

Answer 20

Pyramidal pattern

Disproportionately affects upper limb extensors + lower limb flexors

Question 21

Describe the pattern of weakness in LMN lesions

Answer 21

Focal pattern

Only muscles directly innervated by damaged neurones affected

Question 22

Which 4 movements can be used for assessing power in the shoulders, elbows, wrists and fingers?

Answer 22

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

Question 23

What nerves are tested in the biceps reflex?

Answer 23

C5

C6

Question 24

What nerves are tested in the triceps reflex?

Answer 24

C7

Question 25

What nerves are tested in the supinator reflex?

Answer 25

C5

C6

Question 26

What 2 features may be seen on testing coordination of a patient withipsilateralcerebellar pathology?

Answer 26

Dysmetria

Intention tremor

Question 27

What is Dysmetria?

Answer 27

lack of coordination of movement- patient missing the target by over/ undershooting

Question 28

What is Intention tremor?

Answer 28

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.

Question 29

What is an action tremor?

Answer 29

Occurs throughout movement