Upper limb PNS examination

Question 1

what are you inspecting for when you do the upper limb examination

Answer 1

1. Inspects for muscle bulk, fasciculations, tremors, scars, and other skin changes.

Question 2

what do you ask

Answer 2

Tone

- ask them if they are in any pain before you do the test

Question 3

what other examinations would you perform

Answer 3

sensory tests such as

two-point discrimination, vibration sense, proprioception,

Question 4

what are the spinal levels form

• shoulder abdunction
• elbow flexion
• elbow extension
• write flexion/extension
• finger flexion/extension
• finger abduction

Answer 4

Shoulder abduction(C5)
 Elbow flexion(C5/6) Elbow extension(C7/8)
Wrist flexion/extension (C6/7) Finger flexion/extension(C7/8) Finger adduction(T1)

Question 5

what do you use for light touch

Answer 5

For light touch (dorsal column), use cotton wool

Question 6

what do you use for sharp touch

Answer 6

For sharp touch (spinothalamic tract), use a sharp (but blunted) object

Question 7

what do you have to do before you test for touch

Answer 7

• touch the patients sternum first so they have a reference for how it should feel

Question 8

how do you test proprioception for the dorsal column

Answer 8

o With the patient’s eyes closed, gently passively flex/extend a digit at the distal phalynx
o Ask them to say whether you are “moving it up or down”
o Technique is important here so that you do not give cues via fine touch or movements of other
joints.
o If they are unable to do so, move to a more proximal joint until they are correct

Question 9

how do you measure vibration for dorsal column

Answer 9

o Using a 128Hz tuning fork, hit it against a firm surface to start it vibrating
o Place it against the patient’s sternum as a reference
o With their eyes closed, touch the vibrating tuning fork against a distal bony prominence (eg the
interphalangeal joint of their great toe) and ask them to say “Stopped” when they feel you stop the
vibration
o If they are unable to do so, move to a more proximal bony prominence until they are correct