Upper Limb Neurological Examination [Complete]

Question 1

Please assess the tone of the upper limb.

Answer 1

“Im going to assess the tone in your arms which will involve me moving them around. before we begin do you have any pain?”

Support the patient’s arm by holding their hand and elbow.

“Id like you to make your arms go floppy for me”

Test for shoulder, elbow and wrist movement

Question 2

Please assess the power of shoulder abduction and state the myotome being tested for.

Answer 2

“Please place your arms up like this”

“Now id like you to stop me from pushing them down”

C5 (Deltoid)

Question 3

Please assess the power of shoulder adduction and state the myotome and muscle being tested for.

Answer 3

“Please hold your arms up like this”

“Now id like you to stop me from pushing them up”

C6/7 (Teres major, latissimus dorsi and pectoralis major)

Question 4

Please assess the power of elbow flexion and state the myotome and muscle being tested for.

Answer 4

“I want you to hold your arms up like this”

Stabilise the elbow

“Now id like you to stop me from straightening your arm out”

C5/6 (Biceps brachii, corachobrachialis, brachialis)

Question 5

Please assess the power of elbow extension and state the myotome and muscles being tested for.

Answer 5

“I want you to hold your arms up like this”

Stabilise the elbow

“Now id like you to try and straighten your arm for me”

C7 (Triceps brachii)

Question 6

Please assess the power of wrist extension and state the myotome being tested for.

Answer 6

“Id like you to cock your wrist back like this”

Stabilise the wrist

“Now id like you to stop me from straightening them”

C6

Question 7

Please assess the power of wrist flexion and state the myotome being tested for.

Answer 7

“Id like you to place your wrists down like this for me”

Stabilise the wrist

Now id like you to stop me from straightening them

C6/C7

Question 8

Please assess the power of finger extension and state the myotome being tested for.

Answer 8

“Place your arms and hands out like this for me”

Stabilise the wrist

“Stop me from pressing your fingers down”

C7

Question 9

Please assess the power of finger flexion and state the myotome being tested for.

Answer 9

“Bring your hands out like this for me”

Stabilise the wrist

“Now id like you to bring your fingers towards yourself and try to stop me from pushing them down”

Question 10

Please test the biceps reflex of the patient. State the myotome being assessed for.

Answer 10

“Id like to test your reflexes which will involve me tapping on the tend of your arm with a tendon hammer”

“Id like you to go floppy for me”

Feel for the tendon first

C5/C6

Question 11

Please test for the triceps reflex and state the myotome being assessed for.

Answer 11

“Id like to test your reflexes which will involve me tapping on the tend of your arm with a tendon hammer”

“Id like you to go floppy for me”

Feel for the tendon first

C6/C7

Question 12

Please test for the supinator reflex and state the myotome being assessed for.

Answer 12

Locate the brachioradialis tendon which can be found on the posterolateral aspect of the wrist approximately 4 inches proximal to the base of the thumb.

C5/C6

Question 13

Please assess light touch sensation of the dermatomes of the upper limb and name each of the dermatomes as you go along.

Answer 13

“Im am now going to assess for sensation which will involve me getting a piece of cotton wool and placing it against you skin”

“If you close your eyes for me. It should feel like this [Place on sternum]. Could you feel that?”

“Id like you to say yes everytime you can feel it placed against your skin”

N.B. DOES THAT FEEL THE SAME ON BOTH SIDES?

Question 14

Please assess the patient’s proprioception by testing for joint position sense.

Answer 14

“Im just going to take your thumb and show you that this is up and this is down. Im going to ask you to close your eyes for me and tell me if your thumb is pointing up or down.

(Do this 3 times per thumb)

“Open your eyes for me. This is up and this is down [Opposite thumb this time]

N.B. DO NOT TOUCH THE NAILBED AS PRESSURE CAN GIVE A CLUE

Question 15

Please test the patient’s coordination by performing the finger to nose test.

Answer 15

“Im going to test for coordination now so can you touch your nose like this [perform gesture]. Touch my finger (move fingers outwards to the right) and now touch your nose. Now continue to touch my finger and touch your nose.

“Now we will do the same with the other finger. [This time move your finger along slowly left and right to act as a moving target]

Question 16

Please peform the rapid alternating movement test to assess for dysdiachokinesia.

Answer 16

“Id like you to place your hands out like this [gesture with palms facing out]. I want you to place your hands together like this [palms touching] and then place your hands like this [right hands back part on the other palm] and alternate between these movements like so”