Upper limb PNS exam Flashcards
Upon general inspection of the patient, what are you looking for?
- tremors
- muscle wasting + fasciculations (LMN signs)
- resting posture
- bony deformity + skin changes
How do you assess muscle tone in the upper PNS exam?
- *first ask about pain/tenderness before moving their limb
- take the patients hand and ask them to relax
- passively supinate and pronate their forearm
- passively extend and flex their elbow
- hypertonicity (spastic + rigid) = UMN lesion
- hypotonicity (floppy and wasted) = LMN lesion
How do you assess muscle power in the upper PNS exam?
- test each spinal root individually, comparing each side as you go
- ask the patient to perform each movement, and ask them to resist you pulling/pushing against them:
1. shoulder abduction = chicken
2. elbow flexion + extension = boxer
3. wrist flexion/extension = clench fists + push above and below
4. finger flexion/extension = like for like
5. finger adduction = paper
Describe the medical research council power grades.
from 0-5 5 = full power 4 = movement against weak resistance 3 = movement without any resistance 2 = movement without gravity 1 = muscle contraction without joint movement 0 = complete paralysis
How do you assess co-ordination in the upper PNS exam?
- finger-to-nose test
- alternate clapping
* test each arm individually and compare
Describe the finger-to-nose test.
- ask patient to touch their nose with their index finger
- then ask them to touch your finger - hold finger a distance away that the patient has to fully extend their arm to reach you
- ask them to alternate rapidly between touching their nose and your finger
- past-pointing.intention tremor = cerebellar lesion (seen in MS + other neuro conditions)
Describe the alternate clapping test.
- ask the patient to clap on palm on top of the other
- then ask them to turn their hand over and hit the palm with the back of their fingers
- ask them to alternate rapidly between the two
- impaired co-ordination (dysdiadochokinesis) = cerebellar lesion
Which reflexes do you test for in upper limb PNS? How should the patient be positioned?
- Biceps
- Triceps
- Brachioradialis/Supinator
- Hyper-reflexia = UMN lesions
- Hypo-reflexia = LMN lesions
How do you test the biceps reflex? What myotome is this reflex?
- press one finger over the biceps tendon in the antecubital fossa
- strike finger with tendon hammer
- look for biceps twitch or elbow flexion
Myotome: C5/6
How do you test the triceps reflex? What myotome is this reflex?
- tap triceps insertion at the elbow
- look for triceps twitch or elbow extension
Myotome: C7/8
How do you test the brachioradialis/supinator reflex? What myotome is this reflex?
- press one finger over brachioradialis insertion at distal radius
- strike finger with tendon hammer
- look for biceps twitch
Myotome: C5/6
What myotome is shoulder abduction and adduction?
Abduction: C5
Adduction: C6,7
What myotome is elbow flexion?
C5/6
What myotome is elbow extension?
C7
What myotome is wrist extension?
C6
