Upper Limb Neurological Exam Flashcards
Mnemonic for structure of this exam?
To postpone reflexes constitutes stupidity - Tone, power, reflexes, co-ordination, sensation.
How much should the patient be exposed?
Expose both upper limbs from shoulders to fingers.
Summary of general inspection?
Surroundings - Monitoring (ECG - autonomic problems), treatments (O2, IV infusions), paraphernalia (wheelchair, mobility aids etc.).
Patient - Asymmetry, deformity or abnormal posture (dystonia). Often due to abnormal contraction of one group of muscles.
SWIFT - Scars, Wasting of muscles, Involuntary movements, Fasciculations, Tremor
What is writer’s cramp?
Muscles of hand and forearm cramp when patient tries to write.
What is wry neck?
Torticollis - painful contraction of SCM which causes the face to point to one side. Other variants possible; retrocollis - head tilts backwards, antecollis - head tilts forwards.
What is resting tremor indicative of?
Parkinson’s disease
What is intention tremor indicative of?
Cerebellar disorder
Common sites of muscle wasting?
Proximally - deltoid, supra/infraspinatus.
Distally - 1st dorsal interosseous muscle.
What is fasciculation?
Irregular twitches under the skin overlying resting muscles caused by individual motor units firing spontaneously.
What causes pronator drift?
UMN weakness
What is psuedoathetosis?
Proprioceptive loss leading to involuntary, slow snake-like movements of distal regions (fingers and toes).
What is dysmetria?
Lack of co-ordination (due to cerebellar lesion)
What is myoclonus?
Brief jerks that can move a limb. Usually restricted to one muscle group but can be generalised.
What are tics?
Borderline psychiatric/neuro in origin. Tend to affect the face. Main manifestation in Tourette’s, but often benign in normal individuals.
What is TONE?
The resistance felt by the examiner when moving a joint passively.
How do you assess tone in the upper limbs?
- Ask patient to lie supine on examination couch, and to relax and ‘go floppy’. Ask about painful joints or limitations of movement before proceeding.
- Passively move each joint tested through as full a range as possible, both slowly and quickly in all anatomically possible directions.
- Hold the patient’s hand as if shaking hands, using other hand to support elbow. Assess tone at wrist, elbow and shoulder.