Upper Limb Neurological Exam Flashcards
What do you look for on general inspection
Abnormal posture
SWIfT:
Scars Wasting of muscles Involuntary movements fasciculations Tremor
What could you look for during closed eyes supination and pronation of the extended arm
Pronator Drift which is a sign of UMN pyramidal pathology
What could you look for during tone assessment
Cog-wheeling and rigidity (Parkinson’s disease)
Increased tone which is a sign of UMN lesion (such as stroke)
Wasted and floppy could indicate LMN lesion
What spinal root innervates shoulder abduction
C5
What spinal root innervates shoulder adduction
C6/7
What spinal root innervates elbow flexion
C5/6
What spinal root innervates elbow extension
C7
What spinal root innervates wrist extension
C7
What spinal root innervates wrist flexion
C8
What spinal root innervates finger extension
C7
What spinal root innervates finger abduction
T1
What muscle is responsible for index finger abduction
first dorsal interosseous
What muscle is responsible for pinky finger abduction
Abductor digiti minimi
What spinal root innervates thumb abduction
C8/T1
What spinal roots are responsible for the biceps reflex
C5/6
What spinal roots are responsible for the triceps reflex
C7/8
What spinal roots are responsible for the supinator reflex
C5/6
What are the arm dermatomes
Upper lateral arm - C5 Lower lateral arm and thumb - C6 Index, middle and 1/2 ring - C7 1/2 ring, pinky and lower medial arm - C8 Upper medial arm - T1
What tuning fork is used during vibration sensation
128Hz
What bone is the tuning fork placed on
Thumb Distal interphalangeal joint
What do you do when the patient cannot feel vibration
Assess vibration at a more proximal bony point
What do you observe for in the coordination test
Intention tremor
Past pointing
Both are indicative of cerebellar disease
What does the rapid hand rotation highlight
Dysdiadokinesia which could indicate a cerebellar lesion
What examinations could you do to complete findings
Cranial nerve examination
Lower limb examination
Gait examination
What spinal root innervates finger flexion
C8
What does weakness in power indicate
Damage to either UMN or LMN
What are the Medical Research Council (MRC) Power Grades
5 - full power 4 - Weak movement against resistance 3 - Movement without any resistance 2 - Movement without gravity 1 - Muscle contraction without joint movement 0 - Complete paralysis
What could weak or strong reflexes indicate
Hyper-reflexia - UMN lesion
Hypo-reflexia - LMN lesion
What tract does cotton wool test
Dorsal Column (fine touch)
What tract does the neuro-tip test
Spinothalamic tract (sharp pain)
