Upper Limb Neuro Exam Flashcards
What are some upper motor neurone signs?
- Hypertonicity (spasticity)
- “Pyramidal” pattern of weakness
- Hyper-reflexia
- Pronator Drift
- Babinski positive (not in upper limb)
Potentially:
- Disuse atrophy
What are some lower motor neurone signs?
- Muscle wasting
- Fasciculations
- Hypotonia
- Varying patterns of weakness
- Hyporeflexia or areflexia
What around the bed may suggest neurological problems?
- Wheelchair
- Walking aids
- Catheter
What menmonic can help with a neuro visual inspection?
A SWIFT
What does the mnemonic A SWIFT mean?
A - Asymmetry
S - Scars
W - Wasting
I - Involuntary movements
F - Fasciculations
T - Tremor
What are some involuntary movements to look for in neuro inspection?
- Dystonia
- Chorea
- Myoclonus
- Athetosis
- (Fasciculations)
- (Tremor)
What is an important distinction to make about tremors?
Resting vs Kinetic
Involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both
Dystonia
Random-appearing sequence of one or more discrete involuntary movements
Chorea
Slow, continuous, involuntary writhing movements often affecting the extremities
Athetosis
Repeated, often non-rhythmic, brief shock-like jerks due to sudden involuntary contraction or relaxation of one or more muscles
Myoclonus
Rhythmic back-and-forth or oscillating involuntary movement about a joint axis
Tremor
Give 2 cause of dystonia
- Parkinson’s Disease
- Dyskinetic Cerebral Palsy
Give 2 causes of chorea
- Dyskinetic Cerebral Palsy
- Huntington’s Disease
Give 2 causes of athetosis
- Dyskinetic Cerebral Palsy
- Huntington’s Disease
Give a cause of myoclonus
Myoclonic epilepsy
What is a common cause of resting tremor?
Parkinson’s Disease
What is a common cause of a kinetic tremor?
Benign essential tremor
When inspecting a patient in a neuro exam, what clues may be seen in the face?
- Hypomimia
- Ptosis
- Ophtalmoplegia
What is hypomimia?
Lack of facial expression
What is a common cause of hypomimia?
Parkinson’s Disease
What systemic neurological condition can cause ptosis and ophthalmoplegia?
Myasthenia gravis
What is shown here?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/337/426/297/q_image_thumb.jpg?1565907406)
Muscle wasting (thenar atrophy)
What is a common LMN lesion that can cause thenar eminence wasting?
Carpal Tunnel Syndrome
How is pronator drift tested for?
- Ask patient to close eyes and outstretch arms with palms up
- Observe for pronation
What does a positive pronator drift indicate?
UMN pathology
How is tone assessed in the upper limb?
- Ask patient to let their arm go floppy
- Move each major joint in (wrist to shoulder) all directions
- Pronate and supinate the arm
- Feel for changes in tone
What are some changes in tone?
- Spasticity
- Rigidity
What is spasticity?
Velocity dependent increase in tone - the faster you move it the worse it is
What is rigidity?
Velocity independent increased tone - same at all speeds
What does spasticity indicate?
UMN lesion
What does rigidity indicate?
Extrapyramidal lesion
What is a major cause of rigidity?
Parkinson’s Disease
What type of rigidity in the arms is often seen in Parkinson’s disease?
Cogwheeling
What is cogwheeling?
Ratchet-like start-and stop movements through the range of motion
How should power be assessed in the upper limbs?
- Assess each function one side at a time, comparing like for like
- Stabilise limb to isolate the joint
- Test each muscle group with your own similar muscle group e.g. thumb vs thumb
- Use MRC muscle power assessment scale
Power in which joints should be tested in an upper limb neuro exam?
- Shoudlers
- Elbows
- Wrists
- Finger and thumbs
Power of which shoudler motions should be tested in a neuro exam?
- Abduction
- Adduction
What nerve root(s) provide power of shoulder abduction?
C5
What nerve root(s) provide power of shoulder adduction?
C6/7
Power of which elbow motions should be tested in a neuro exam?
- Flexion
- Extension