UPPER LIMB EXAMINATION Flashcards
How would you start any examination?
WIPER QQ Wash hands Introduce yourself Ask permission Expose the patient Reposition the patient
Ask if they are in any pain or discomfort
How exposed should the patient be for the upper limb neurological examination?
Top half of their body fully exposed
How should the patient be positioned for the upper limb neurological examination?
Lying down at 45 degrees
What are you looking for during your inspection of the upper limb in the neurological examination?
From the end of the bed:
Any pain or discomfort
Any walking aids or signs of chronic discomfort
DWARFS: Deformities Wasting of muscles (especially small muscles of the hand) Asymmetry Rashes Fasciculations Scars
Abnormal posturing
Abnormal movements - tremor, dystonia, athetosis
Pronator drift
What is dystonia and what can it be a sign of?
Substained muscle contractions cause twisting and repetitive movements or abnormal postures.
The disorder may be hereditary or caused by other factors such as birth-related or other physical trauma, infection, poisoning (e.g., lead poisoning) or reaction to pharmaceutical drugs, particularly neuroleptics.
What is athetosis?
Slow, involuntary, convoluted, writhing movements of the fingers, hands, toes, and feet and in some cases, arms, legs, neck and tongue.
Related to degeneration of the basal ganglia as seen in Huntingdon’s disease. It is most commonly caused by a complication at birth.
What is pronator drift, how do you test for it and what is it a sign of?
Ask the patient to close their eyes with there arms out with their forearm in the supine position. Watch for gradual pronation.
Pronator drift can be a sign of pyramidal pathology caused by an upper motor neuron lesion.
Having inspected the patient as part of an upper limb neurological exam, what is the next thing to assess?
Tone
When assessing tone as part of an upper limb neurological exam, what must you ask before starting your assessment?
Whether they are in any pain in their hands, arms or shoulders.
How do you assess tone in a neurological exam of the upper limb?
Ask patient to relax/go floppy like a rag-doll.
Passively flex and extend the limb as well as pronating and supinating the forearm.
You are looking for increased (rigidity/spasticity) or decreased tone.
When might the tone of the upper limb be increased?
Upper motor neuron lesions
Basal ganglia dysfunction (Parkinson’s disease)
When might the tone of the upper limb be decreased?
Lower motor neuron lesions
Having assessed the patient’s muscle tone as part of an upper limb neurological exam, what is the next thing to assess?
Power
When assessing the power of the upper limb what must you remember to do?
Stabilise the joint above
Test each muscle group bilaterally before moving on to the next position - comparing like for like
What are the different movements that you assess the power of during an upper limb exam? For each movement say which muscle group or spinal nerve is being tested.
Abduction - Deltoid C5 Adduction - C6, C7 Flexion at elbow - Biceps C5, C6 Extension at the elbow - Triceps C7 Wrist dorsi flexion - C6, C7 Wrist palmar flexion - C6, C7 Finger extension - C7, C8 Finger flexion - C8 Finger abduction - T1 Finger adduciton - T1 Thumb abduction - C8, T1 Thumb opposition - Pincer movement C8, T1 Power grip - C5-T1
How do you assess the power of finger adduction in the neurological exam of the upper limb?
Get the patient to hold a piece of paper between two extended fingers of the same hand. Do the same and pull the paper away.
What scale is power measured on when assessing the neurological status of the upper limb?
MRC scale for power