Upper limb examination Flashcards
1
Q
Describe position
A
- Upper limb 45 degrees
- Lower limb legs handing off the couch
2
Q
Describe general inspection of the bedside
A
- Wheelchair
- Incontinence
- Walking aid
3
Q
Describe general inspection of patient
A
- Scars
- Wasting
- Involuntary movements
- Fasciculations
- Tremor
- Specific signs (Neurofibromas, horners)
4
Q
Describe pronator drift
A
- Patient closes eyes and tries to hold hands supinated
- In pronator drift the hand drifts to become pronated
- Upper motor neuron lesion is on the contralateral side to the drift
5
Q
Describe assessment of tone
A
- Ensure the patient is floppy
- Shoulder (circumduction)
- Elbow (flexion extension)
- Wrist (flexion extension)
- Assess whether normal, reduced (hypotonia -LMN) or increased (hypertonia - spasticity or rigidity, UMN)
6
Q
Compare spasticity and rigidity
A
- Spasticity resistance not proportional to velocity (high resistance then a breaking point)
- Rigidity is where resistance is proportional to force
7
Q
Describe examination of power
A
- Shoulder abduction (C5) and adduction (C6/7)
- Elbow flexion (C5/6) and extension (C7)
- Wrist flexion (C6/7) and extension (C6)
- Finger abduction (T1)
- Thumb abduction (C8/T1)
8
Q
Describe muscle power scale
**
A
–
9
Q
List reflexes tested in upper limb
A
- Biceps C5/6 - put finger over tendon and hit tendon
- Triceps C6/7 - take the weight of the arm and hit tendon directly
- Supinator reflex - C5/6 (brachioradialis tendon, hit fingers)
- To make reflex stronger ask to clench jaws
10
Q
Describe types of reflex
A
- Normal
- Hyporeflexia (lower motor neurone)
- Hyperrelexia (increased seen in upper motor neurone)
11
Q
Describe examination of sensation
A
- Normal on sternum
- Light touch (cotton wool - dorsal column)
- Pin prick/pain sensation (neurotip - spinothalamic tract, alternate sharp and blunt)
- Go along dermatome (C5 upper arm lateral, C6 thumb, C7 middle C8 pinkie, T1 medial upper arm)
12
Q
Describe examination of vibration sensation
A
- 128Hz tuning fork
- Start on distal bony prominence (IPJ thumb)
- If unable to feel vibration move proximally from CMCJ thumb to wrist to elbow)
13
Q
Describe proprioception test
A
- Eye open
- Demonstate what you will do
- Isolate IP thumb joint, move up/down
- Ask them to say which position it is in a random order. If incorrect move proximally
- Do a small movement
14
Q
Describe assessment of coordination
A
- Alternate one hand palm up and down as fast as you can, resting on the other hand. In dysdiodokinesia this is slow (cerebellar)
- Finger nose test (move finger from their nose to your finger, causing patient to fully extend arm, and move pen look for intention tremor and pass pointing - cerebellar)
15
Q
List clinical signs seen in a patient with cerebellar damage
A
- Dysarthria (slurred speech)
- Ataxia
- Hypotonia
- Nystagmus
- Dysdiadokinesia
