Upper Limb Examination

Question 1

General examination

Answer 1

Look at whole patient
Vote any aids or orthoses

Question 2

Tips

Answer 2

Passive doesn’t need to be done if active is ok
Look around bed for walking aid
Resisted only on big joints

Question 3

Shoulder

Answer 3

Look, feel, move, special test
Undress
Standing
Space

Skin
Posture and symmetry
Bony structures – clavicles
Joint swelling
Muscle bulk – supraspinatus, infraspinatus, deltoid

Ask if it hurts?
Standing behind patient, feel: !Sternoclavicular joint
!Clavicle
!Acromioclavicular joint
!Acromion
!Corocoid process
!Greater tuberosity
!Scapula: spine, medial border, inferior angle

Remember to compare both sides
Flexion
Ask patient to lift their straight arm out to the front Normal is 90° without scapular movement
180° with scapular movement

Extension
Swing straight arm back Normal is 50°

Abduction
!Ask the patient to lift arm out to side
!Normal is 90° without scapula or 180° with scapula
Adduction
!Ask patient to move arm across front of body !Normal is 40°

Internal rotation
!Ask patient to put hand on middle of back
External rotation
!Ask patient to put hand on the back of their head
Painful arc

If any active movement is reduced, test passive movements

Resisted movements !Infraspinatus (external rotation)
!Subscapularis (internal rotation) !Supraspinatus (abduction) !Deltoid (abduction)

Question 4

Elbow

Answer 4

Positioning
Undress to see shoulder also
Seated
Space

Look-elbow :anteriorly, posteriorly, laterally
Skin / soft tissue – olecranon bursa / nodules Posture and symmetry – carrying angle
Bone
Joint swelling
Muscle bulk

Feel (1) – elbow
Olecranon process
Lateral epicondyle of humerus Medial epicondyle of humerus Ulnar
Head of radius

Move (1) – elbow
Flexion
!Ask patient to bend elbow !Normal is 150- 160°
Extension
!Ask patient to straighten arm !No fixed flexion should be seen

Pronation
Ask the patient to bend elbow to 90° of flexion and then turn arm over so palm faces the floor
Supination
As above but with the palm facing upwards

Resisted movements Flexion (biceps)
Extension (triceps) Supination (supinator) Pronation (pronator)

Question 5

Hand and wrist

Answer 5

See other notes