Upper limb examination

Question 1

What is involved in inspection of the upper limb in the UL exam?

Answer 1

Look for:

Fasciculations (LMN lesion)

Involuntary/abnormal movements

Deformities or abnormal postures (due to unbalanced, weakened muscles)

Any muscle wasting (LMN lesion, neuropathy, motor neurone disease)

Question 2

What is done to assess tone in the UL exam?

Answer 2

Elbow: pronation and supination

Wrist: rotation

Comment on tone: normal, hypertonic, hypotonic

Question 3

How is power assessed in the UL exam?

Answer 3

Shoulder abduction and adduction

Elbow flexion and extension

Wrist flexion and extension

Finger extension, flexion, abduction, adduction

Score power from 0-5 (0 = paralysis, 5 = normal)

Question 4

What reflexes are assessed in the UL exam?

Answer 4

Biceps, triceps, brachioradialis

Question 5

How is coordination and RAM tested in the UL exam?

Answer 5

Coordination = finger-nose testing, followed by closed eyes

Dysdiadochokinesis tested by asking patient to alternate between pronation and supination of hand on dorsum of other hand

Rapidly alternating movement also tested by asking patient to alternate finger tapping on palm of hand

Question 6

How do we test for sensation in the UL exam?

Answer 6

Light touch using cotton ball

Pain using sharp/blunt tip

Joint position using tuning fork on DIP of thumb, moving proximally if patient isn’t able to feel

Remember to pay attention to dermatomes (C5-T1)

C5 = lateral arm

C6 = lateral forearm/thumb

C7 = middle finger

C8 = little finger

T1 = medial arm