Upper limb neuro Flashcards
How do you start the exam?
Wash hands Intro Patient details Consent Exposure
What should you ask patient before beginning?
Any pain?
Which hand is dominant?
What do you look for on inspection?
Posture Wasting Tremor Fasciculations Involuntary movements
What are the UMN lesion signs on inspection?
No fasciculation or wasting
What are the LMN lesion signs on inspection?
Wasting
Fasciculation
How do you assess tone?
Hold patients hand and elbow Move wrist Pronate and supinate Move elbow Move shoulder
What are you assessing for in tone?
Smoothness
Ridigity
Spasticity
Flaccidness
What is the difference between rigidity and spasticity?
Spasticity is worse the quicker you move the limb
What does spasticity indicate?
UMN lesion
What does rigidity indicate?
Extrapyramidal lesion (parkinsonism)
What does flaccidness indicate?
LMN lesion
What is a sign specific to parkinsonism?
Cogwheeling (ratchet like stop start movements)
Describe the MRC grading system
5 = full power 4 = reduced power resistance (- and +) 3 = movement against gravity 2 = movement with no gravity 1 = muscle flicker 0 = no muscle constraction
What action is myotome c5?
Bicep reflex
What action is myotome c6?
Bicep reflex
Supinator reflex
What action is myotome c7?
Tricep reflex
How do you test for pronator drift?
Patient hold both arms out palms down with eyes closed.. look for pronator drift
How do you test shoulder power?
Don’t let me push your shoulders down (C5)
Don’t let me pull your arms away (C6/7)
How do you test for elbow power?
Don’t let me pull your arm away (C5/6)
Don’t let me push against your arm (C7)
How do you test for forearm/wrist power?
Cock your wrists dont let me pull them down (C6)
Point your wrists down and dont let me pull them up (C6/7)
How do you test for finger power?
Don’t let me push your straight fingers down (C7)
Don’t let me push your splayed fingers together (T1)
How do you test thumb abduction?
Point your thumbs to ceiling and don’t let me push them down (C8/T1)
What power sign shows an UMN lesion?
Pyramidal weakness (bent arms flexed legs)
What power sign shows an LMN lesion?
Proximal weakness in muscle disease
Distal weakness in peripheral neuropathy
How do you test peripheral nerve supply with the thumb
Palmar abduction (median)
Adduction (ulnar)
Opposition (median)
What reflexes do you test?
Biceps
Tendons
Supinator
What are the reflex signs for UMN lesion?
Brisk or exaggerated
What are the reflex signs for a LMN lesion?
Reduced or absent
How do you test for coordination?
Finger to nose test (cerebellar pathology) Dysdiadochokinesia (cerebellar ataxia) Fine movement (fingers to thumb rapidly)
Where do you test each dermatome?
C5 - laterally in line with armpit C6 - tip of the thumb C7 - tip of first finger C8 - tip of the little finger T1 - medial elbow
How do you test light touch?
Use cotton wool
Test on sternum
Compare left to right
How do you test vibration sensation?
Ask patient to close eyes
Place 128hz tuning fork on sternum
Test on distal interphalangeal joint of forefinger
How do you test proprioception?
Show them thumb moving up and down
Move thumb up or down and ask which
Move proximally if they can’t identify
What do you state you would test?
Pin prick
Temperature
What else do you test for sensation?
Cortical localisation
2 point discrimination
Graphaesthesia
How do you test cortical localisation?
Place key or coin in hand with eyes close and ask to identify
How do you test 2 point discrimination?
With calipers at a set distance on tip of finger
How do you test for graphaesthesia?
Write number on palm with point (eyes closed)
How do you finish the exam?
Thank patient
wash hands
present
