Upper Limb Neurology Examination Flashcards
On general inspection looking for:
Patient posture, habitus & other signs of neurological conditions e.g. hypomimia & facial muscle wasting
Around bed: mobility aids & orthoses
Local inspection looking for:
Tremors
Muscles: look in general then look for thenar/hypothenar wasting, dorsal hand guttering (LMN lesion) and fasciculations (LMN lesion)
Skin: neurofibromas, cafe au lait spots, scars including small muscle biopsy scars
Dorsal hand guttering and fasciculations are signs of what kind of lesion?
LMN
Pronator drift and distal flexion is a sign of?
Pyramidal weakness
Upward drift of outstretched arms is a sign of?
And is accentuated by?
Cerebellar pathology
“Rebound” - pushing patients wrists down briskly and quickly letting go
Shoulder abduction tests which nerve root?
C5 - deltoid
Elbow flexion tests which nerve root?
C6 - brachioradialis
Elbow extension tests which nerve root?
C7
Wrist extension (dorsiflexion) tests which nerve root?
C7 - wrist extensors
Wrist flexion (palmar/volar flexion) tests which nerve root?
C7
Finger extension tests which nerve root?
C7 C8 - long extensors
Finger flexion tests which nerve root?
C8 - long flexors
Finger abduction and thumb abduction tests which nerve root?
T1
Conditions causing a positive prayer sign? (cannot flatten hands)
“put your palms together and push your elbows outwards”
Rheumatoid arthritis Scleroderma Diabetes - cheiro-arthropathy Ulnar nerve palsy - partial claw hand T1 palsy - complete claw hand Dupytren's contracture
Pincer grip tests which muscle & nerve?
Adductor policis - innervated by the ulnar nerve
What can cause damage to the ulnar nerve?
Medial epicondyle fracture
What is Froment’s sign
Flexion of thumb in ulnar nerve palsy on attempted pincer grip
produces O of frOmen’ts sign
because long flexors are supplied by median nerve–> act when adductor policis is weak
