Upper Limb Neurological Exam

Question 1

What do you look for on general inspection

Answer 1

Abnormal posture

SWIfT:

Scars
Wasting of muscles
Involuntary movements
fasciculations
Tremor

Question 2

What could you look for during closed eyes supination and pronation of the extended arm

Answer 2

Pronator Drift which is a sign of UMN pyramidal pathology

Question 3

What could you look for during tone assessment

Answer 3

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

Question 4

What spinal root innervates shoulder abduction

Answer 4

C5

Question 5

What spinal root innervates shoulder adduction

Answer 5

C6/7

Question 6

What spinal root innervates elbow flexion

Answer 6

C5/6

Question 7

What spinal root innervates elbow extension

Answer 7

C7

Question 8

What spinal root innervates wrist extension

Answer 8

C7

Question 9

What spinal root innervates wrist flexion

Answer 9

C8

Question 10

What spinal root innervates finger extension

Answer 10

C7

Question 11

What spinal root innervates finger abduction

Answer 11

T1

Question 12

What muscle is responsible for index finger abduction

Answer 12

first dorsal interosseous

Question 13

What muscle is responsible for pinky finger abduction

Answer 13

Abductor digiti minimi

Question 14

What spinal root innervates thumb abduction

Answer 14

C8/T1

Question 15

What spinal roots are responsible for the biceps reflex

Answer 15

C5/6

Question 16

What spinal roots are responsible for the triceps reflex

Answer 16

C7/8

Question 17

What spinal roots are responsible for the supinator reflex

Answer 17

C5/6

Question 18

What are the arm dermatomes

Answer 18

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

Question 19

What tuning fork is used during vibration sensation

Answer 19

128Hz

Question 20

What bone is the tuning fork placed on

Answer 20

Thumb Distal interphalangeal joint

Question 21

What do you do when the patient cannot feel vibration

Answer 21

Assess vibration at a more proximal bony point

Question 22

What do you observe for in the coordination test

Answer 22

Intention tremor
Past pointing

Both are indicative of cerebellar disease

Question 23

What does the rapid hand rotation highlight

Answer 23

Dysdiadokinesia which could indicate a cerebellar lesion

Question 24

What examinations could you do to complete findings

Answer 24

Cranial nerve examination
Lower limb examination
Gait examination

Question 25

What spinal root innervates finger flexion

Answer 25

C8

Question 26

What does weakness in power indicate

Answer 26

Damage to either UMN or LMN

Question 27

What are the Medical Research Council (MRC) Power Grades

Answer 27

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

Question 28

What could weak or strong reflexes indicate

Answer 28

Hyper-reflexia - UMN lesion

Hypo-reflexia - LMN lesion

Question 29

What tract does cotton wool test

Answer 29

Dorsal Column (fine touch)

Question 30

What tract does the neuro-tip test

Answer 30

Spinothalamic tract (sharp pain)