Upper limb neuro

Question 1

How do you start the exam?

Answer 1

Wash hands
Intro
Patient details
Consent
Exposure

Question 2

What should you ask patient before beginning?

Answer 2

Any pain?

Which hand is dominant?

Question 3

What do you look for on inspection?

Answer 3

Posture
Wasting
Tremor
Fasciculations
Involuntary movements

Question 4

What are the UMN lesion signs on inspection?

Answer 4

No fasciculation or wasting

Question 5

What are the LMN lesion signs on inspection?

Answer 5

Wasting

Fasciculation

Question 6

How do you assess tone?

Answer 6

Hold patients hand and elbow
Move wrist
Pronate and supinate
Move elbow
Move shoulder

Question 7

What are you assessing for in tone?

Answer 7

Smoothness
Ridigity
Spasticity
Flaccidness

Question 8

What is the difference between rigidity and spasticity?

Answer 8

Spasticity is worse the quicker you move the limb

Question 9

What does spasticity indicate?

Answer 9

UMN lesion

Question 10

What does rigidity indicate?

Answer 10

Extrapyramidal lesion (parkinsonism)

Question 11

What does flaccidness indicate?

Answer 11

LMN lesion

Question 12

What is a sign specific to parkinsonism?

Answer 12

Cogwheeling (ratchet like stop start movements)

Question 13

Describe the MRC grading system

Answer 13

5 = full power
4 = reduced power resistance (- and +)
3 = movement against gravity
2 = movement with no gravity
1 = muscle flicker
0 = no muscle constraction

Question 14

What action is myotome c5?

Answer 14

Bicep reflex

Question 15

What action is myotome c6?

Answer 15

Bicep reflex

Supinator reflex

Question 16

What action is myotome c7?

Answer 16

Tricep reflex

Question 17

How do you test for pronator drift?

Answer 17

Patient hold both arms out palms down with eyes closed.. look for pronator drift

Question 18

How do you test shoulder power?

Answer 18

Don’t let me push your shoulders down (C5)

Don’t let me pull your arms away (C6/7)

Question 19

How do you test for elbow power?

Answer 19

Don’t let me pull your arm away (C5/6)

Don’t let me push against your arm (C7)

Question 20

How do you test for forearm/wrist power?

Answer 20

Cock your wrists dont let me pull them down (C6)

Point your wrists down and dont let me pull them up (C6/7)

Question 21

How do you test for finger power?

Answer 21

Don’t let me push your straight fingers down (C7)

Don’t let me push your splayed fingers together (T1)

Question 22

How do you test thumb abduction?

Answer 22

Point your thumbs to ceiling and don’t let me push them down (C8/T1)

Question 23

What power sign shows an UMN lesion?

Answer 23

Pyramidal weakness (bent arms flexed legs)

Question 24

What power sign shows an LMN lesion?

Answer 24

Proximal weakness in muscle disease

Distal weakness in peripheral neuropathy

Question 25

How do you test peripheral nerve supply with the thumb

Answer 25

Palmar abduction (median) Adduction (ulnar) Opposition (median)

Question 26

What reflexes do you test?

Answer 26

Biceps Tendons Supinator

Question 27

What are the reflex signs for UMN lesion?

Answer 27

Brisk or exaggerated

Question 28

What are the reflex signs for a LMN lesion?

Answer 28

Reduced or absent

Question 29

How do you test for coordination?

Answer 29

``` Finger to nose test (cerebellar pathology) Dysdiadochokinesia (cerebellar ataxia) Fine movement (fingers to thumb rapidly) ```

Question 30

Where do you test each dermatome?

Answer 30

``` 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 ```

Question 31

How do you test light touch?

Answer 31

Use cotton wool Test on sternum Compare left to right

Question 32

How do you test vibration sensation?

Answer 32

Ask patient to close eyes Place 128hz tuning fork on sternum Test on distal interphalangeal joint of forefinger

Question 33

How do you test proprioception?

Answer 33

Show them thumb moving up and down Move thumb up or down and ask which Move proximally if they can't identify

Question 34

What do you state you would test?

Answer 34

Pin prick | Temperature

Question 35

What else do you test for sensation?

Answer 35

Cortical localisation 2 point discrimination Graphaesthesia

Question 36

How do you test cortical localisation?

Answer 36

Place key or coin in hand with eyes close and ask to identify

Question 37

How do you test 2 point discrimination?

Answer 37

With calipers at a set distance on tip of finger

Question 38

How do you test for graphaesthesia?

Answer 38

Write number on palm with point (eyes closed)

Question 39

How do you finish the exam?

Answer 39

Thank patient wash hands present