Upper Limb Examination Flashcards

1
Q

What is the order in which upper limbs would be examined?

A
  • Observation
  • Tone
  • Power
  • Coordination
  • Reflexes
  • Sensation
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2
Q

Upper Limb Observation:
What do you look for?

A

SWIFT
* S: Scars/skeletal deformity
* W: muscle wasting/atrophy
* I: Involuntary muscle movement
* F:Fasiculations (muscle)
* T: Tremor

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3
Q

What does muscle wasting/atrophy suggest?

A
  • Denervation -> Lower motor neurone (LMN) lesions
  • Disuse -> long term upper motor neurone (UMN) lesions
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4
Q

What is dystonia?

Involutary muscle movement

A

Sustained muscle contractions which
are twisting & repetitive

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5
Q

What are chorea and athetosis?

A

Writhing movements

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6
Q

What is ballismus?

A

Violent flinging movements

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7
Q

What are ticks?

A

Repetitive and stereotyped – these can be suppressed by the patient, unlike those described above.

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8
Q

What are muscle fasiculations a sign of?

A

Denervation

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9
Q

How should tremours be described?

A

Speed
Amplitude
When the tremour is maximal (rest/active movement)

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10
Q

What are 2 commonly found tremors?

A
  • Physiological – fine, fast upper limb tremor. Increased by anxiety, hyperthyroidism, alcohol excess & some drugs.
  • Parkinsonian – slow, coarse, greater at rest, mostly upper limbs & usually asymmetrical.
    ‘pill rolling’
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11
Q

What is tone?

A

Resistance felt by the examiner when moving a joint though its range of motion. The tone can be normal, decreased (hypotonia) or increased (hypertonia)

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12
Q

What are the 2 main types of hypertonia?

A

Spaticity: velocity-dependent resistance to passive movement
**Rigidity: **sustained resistance even with slow movement, increased tone present throughout whole range of movements

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13
Q

What is spasticity a sign of?

A

UMNL
* Accompanied by weakness and hyper-reflexia
* Extensor plantar response and ankle clonus

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14
Q

How is tone tested?

A

Before undertaking passive movement of the limbs,
it is necessary to check that this is not likely to
cause pain. Ask the patient to relax, and test tone
by performing passive movement:
* Elbow flexion and extension, forearm pronation & supination and wrist flexion & extension.
Passive movements that are sudden and unpredictable, but still gentle, are probably the best way to eliminate
voluntary muscle contraction.

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15
Q

How is power tested?

A

Test agaisnt resistance:
• shoulder abduction: elbows in teh air, try push down arms
• elbow flexion and extension: pull toards/push away
• wrist flexion and extension: cock wrist back/ bend fist down
• finger flexion and extension: flex at metacarpophalngeal joint/mokey grip and dont let uncurl fingers
• the intrinsic muscles of the hand: spread fingers apart, dont let close them
* Grip: squeeze fingers
* Pronaror drift: hold out arms straight in front, plams up to ceiling, close eyes. Watch for drifting of arms downwards or into pronation

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16
Q

Which nerve innervates finger extensor muscles?

A

Radial n.

17
Q

Which spinal nerve innervates muscles of finger flexion?

A

C8

18
Q

What nerve innervates the hand abductor muscles?

A

Ulnar n.

19
Q

Which nerve innervates abductor pollicis?

A

Median n.

20
Q

Which nerves innervate the muscles required to perform the griping of the hand?

A

Median and ulnar n.

21
Q

What is positive pronator drift sign a sign of?

A

Cerebral hemisphere problem (not limb problem)

22
Q

How is coordination tested?

A

Hold out arms outstretched in front
* Finger nose test: as pt to touch tehir nose with index finger, then your finger, back and foth (test both sides, one at a time)
* Rapid alternating hand movements (dysdiadochokinesis): ask pt to hold left hand still and tap rapidly with right hand (pronated and supinated) (repeat on both sides)

23
Q

How are reflexes tested?

A

Palpate muscle tendon, ask pt to relax. Talk/distract the patient

  • Biceps: place your thumb or index finger over
    the biceps tendon and then strike your own
    thumb or finger.
    • Supinator: place your thumb or index finger
    over a point 3-4 cm above the distal end of the
    radius with the patient’s arm semi-pronated
    and then strike your own thumb or finger.
    • Triceps: strike the tendon directly about 2
    cm above the olecranon whilst supporting the
    weight of the arm

Test both sides with reinforcement

24
Q

Which spinal nerve(s) innervate the biceps reflex?

A

C5/6

25
Q

Which spinal nerve(s) innervates the supinator reflex ?

A

C6

26
Q

Which spinal nerve innervates triceps reflex?

A

C7

27
Q

How is sensation tested?

A

• Light touch: cotton wool. Touch dermatomes C5-T1
• Pinprick (pain):neurotip, touch dermatomes C5-T1
• Vibration: distally 128 Hz tuning fork on DIP joint of finger. If cannot be felt, move to more proximal joint
• Joint position sense (proprioception): close eyes, move finger up and down

28
Q

Which tuning fork is used for virbartion sense?

A

128 Hz (large)

29
Q

Which spinal pathway carries fibres for fine touch, proprioception, vibration sense?

A

Dorsal column

30
Q

Which spinal pathwya carries fibres for pain and temperature sensation?

A

Spinothalamic