Upper Limb Assessment

Question 1

Equipment

Answer 1

• Tendon hammer
• Neurotip
• Cotton wool
• Tuning fork (128Hz)

Question 2

Clinical Signs of pathology

Answer 2

Wasting of muscles
Tremor
Fasciculations
Pseudoathertosis
Chorea
Myoclonus
Hypomimia
Opthalmoplegia

Question 3

What is pronator drift

Answer 3

If the forearm pronates, with or without downward movement, the patient is considered to have pronator drift on that side. The presence of pronator drift indicates a contralateral pyramidal tract lesion. Pronation occurs because, in the context of an UMN lesion, the supinator muscles of the forearm are typically weaker than the pronator muscles.

Question 4

Feeling for in tone

Answer 4

Feel for abnormalities of tone as you assess each joint (e.g. spasticity, rigidity, cogwheeling, hypotonia).

Question 5

What is spasticity present with compared with rigidity

Answer 5

pyramidal tract lesions(e.g. stroke) andrigidityis associated withextrapyramidal tract lesions(e.g. Parkinson’s disease).

Question 6

Difference between spasticity and rigidity

Answer 6

Spasticityis “velocity-dependent”, meaning the faster you move the limb, the worse it is. There is typically increased tone in the initial part of the movement which then suddenly reduces past a certain point (known as “clasp knife spasticity”). Spasticity is also typically accompanied by weakness.

Rigidityis “velocity independent” meaning it feels the same if you move the limb rapidly or slowly.

Question 7

Shoulder power

Answer 7

AbductionC5 - deltoid
AdductionC6/7 - teres major, lat dorsi, pec major

Question 8

Elbow power

Answer 8

Flexion - C5/6 - biceps brachii, coracobrachialis and brachialis
Extension - C7 - triceps brachii

Question 9

Wrist power

Answer 9

Extension - C6 - extensors
Felxion - C6/7 - flexors

Question 10

Finger power

Answer 10

Extension - C7
Abduction - T1
Thumb Abduction - T1

Question 11

Reflex

Answer 11

Biceps
Supinator
Triceps

Question 12

Hyperreflexia vs hyporeflexia

Answer 12

Hyperreflexiais typically associated withuppermotorneuronlesions (e.g. stroke, spinal cord injury) due to the loss of inhibition from higher brain centres which normally exert a degree of suppression over the lower motor neuron reflex arc.

Hyporeflexiais typically associated withlowermotorneuronlesions (e.g. brachial plexus pathology or other peripheral nerve injuries) due to loss of the efferent and afferent branches of the normal reflex arc.

Question 13

Dermatomes

Answer 13

• C5:the lateral aspect of the lower edge of the deltoid muscle (known as the “regimental badge”).
• C6:the palmar side of the thumb.
• C7:the palmar side of the middle finger.
• C8:the palmar side of the little finger.
• T1:the medial aspect antecubital fossa, proximal to the medial epicondyle of the humerus.

Question 14

Where to do proprioception

Answer 14

Thumb

Question 15

How to check coordination

Answer 15

Finger to nose
Dysdiadochokinesia

Question 16

Further investigations

Answer 16

• Full neurological examination including the[cranial nerves],[lower limbs]and[cerebellar assessment]
• Neuroimaging (e.g.[MRI spine and head]

Question 17

Mononeuropathies

Answer 17

Mononeuropathiesresult in a localised sensory disturbance in the area supplied by the damaged nerve.

Question 18

Peripheral neuropathy

Answer 18

symmetrical sensory deficits in a ‘glove and stocking’ distribution in the peripheral limbs. The most common causes of peripheral neuropathy are diabetes mellitus and chronic alcohol excess.

Question 19

Radiculopathy

Answer 19

occurs due to nerve root damage (e.g. compression by a herniated intervertebral disc), resulting in sensory disturbances in the associated dermatomes.

Question 20

Spinal cord damage

Answer 20

results in sensory loss both at and below the level of involvement in a dermatomal pattern due to its impact on the sensory tracts running through the cord.

Question 21

Thalamic lesions

Answer 21

(e.g. stroke) result in contralateral sensory loss.

Question 22

Myopathies

Answer 22

often involve symmetrical proximal muscle weakness.

Question 23

C5 axillary

Answer 23

Deltoid Shoulder ABduction Lateral aspect of the lower edge of the deltoid muscle

Question 24

C5-C6 musculocutaneous

Answer 24

Biceps Elbow flexion Palmar side of the thumb Biceps

Question 25

Radial C7

Answer 25

Extensors (extensor carpi radialis/ulnaris and digitorum) Wrist/finger extension Palmar side of the middle finger Triceps

Question 26

Ulnar T1

Answer 26

First dorsal interosseus (FDI) Index finger ABduction Palmar side of the little finger

Question 27

Median T1

Answer 27

Abductor pollicis brevis (APB) Thumb ABduction Medial aspect of the inferior portion of the upper arm, superior to the elbow joint