Upper limb neuro

Question 1

Intro

Answer 1

Introduce myself, ID

Consent

Wash hand

Ask for limb or joint pain

Question 2

Inspection [7]

Answer 2

Wasting

Limb symmetry

Fixed deformities

Scars

Hands- palmar and dorsal

Abnormal movements

Use of any aid/ euipment.

Question 3

Tone

Answer 3

Assess how easy it is for joints to move

• Elbow
• Wrist

Pronation, supination

Is it hypertonic, normal or hypotonic

Question 4

Order of examination [7]

Answer 4

Intro

Inspection

Tone

Power

Reflex

Co-ordination

Sensation

Question 5

Power [7]

Answer 5

Shoulder abduction and adduction
- Patient abduct against hand by lifting elbows

Elbow flexion and extension
- Support elbow, patient pushes against hand (like arm wrestle)

Wrist extension
- Hold wrist, patient pushes knuckle back against hand

Finger extension and flexion

• Extend- karate chop dorsal fingers
• Flex- patient grips fingers

Observation

• Grade 0-5
• Absent, normal, reduced

Question 6

Relfexes [3]

Answer 6

Elbow flexed, resting on pillow.

Tendon hammer

• Biceps: C5/6
• Triceps: C7
• Supinator: C6

Observation
Absent
Reduced
Normal

Question 7

Co-ordination [2]

Answer 7

Finger nose test

Dysdiadochokinesia

Question 8

Sensation [3]

Answer 8

Fine touch
- Cotton wool on each dermatome

Vibration
- Tuning fork: start at proximal interphalangeal if no sensation then distal, then metacarpophalangeal, wrist, elbow.

Joint position

• Joint examined in the same order as vibration
• Show patient that extend= up and flex= down

Question 9

Dermatomes

- C4-T2

Answer 9

C4- shoulder

C5- Lateral upper arm

C6- Lateral forearm, thumb, index

C7- Middle finger

C8- Little finger, medial hand

T1- Medial forearm

T2- Medial upper arm