Upper Limbs Exam Flashcards
What to look for on inspection of upper limbs
Scars
Wasting
Involuntary movements
Fasciculations
Tremor
UMN pattern of weakness
Pyramidal pattern
Extensors in arms
Flexors in legs
LMN pattern of weakness
Focal pattern of weakness
What does pronator drift assess for?
UMN lesion
Contralateral pyramidal tract lesion
Supinators weaker than pronators
Tone in UMN and LMN lesions
UMN: HYPERtonia
LMN: HYPOtonia
Spasticity
Pyramidal tract lesion e.g. stroke
Velocity dependent
Faster you move the limb, the worse it is
Rigidity
Extrapyramidal tract lesion e.g. PD
Velocity independent
Feels same regardless of how fast you move the limb
What is cogwheel rigidity? In which condition is it seen?
Tremor superimposed on hypertonia resulting in intermittent increase in tone during movement
PD
What is lead pipe rigidity? In which condition is it seen?
Uniformly increased tone throughout movement
Neuroleptic malignant syndrome
MRC Grading scores
0 No contraction
2 Flicker/ trace of contraction
2 Active movement (without gravity) e.g. swimming pool or moving perpendicular to gravity e.g. left to right across bed but cant lift off bed
3 Active movement (against gravity)
4 Active movement (against gravity
Shoulder ABduction
C5
Axillary nerve
Deltoid
Shoulder ADDuction
C6/7
Teres Major, Latissimus dorsi, Pectoralis Major
Elbow FLEXion
C5/6
Musculocutaneous + Radial nerve
Biceps brachii, coracobrachilais, brachialis
Elbow EXtension
C7
Radial nerve
Triceps brachii
Wrist FLEXion
C6/7
Median nerve
Flexors of the wrist
Wrist EXtension
C6
Radial nerve
Extensors of the wrist
Finger extension
C7
Radial nerve
Extensor digitorum
Finger ABduction
T1
Ulnar nerve
First dorsal interosseous (FDI) + Abductor digiti minimi (ADM)
Thumb ABduction
T1
Median nerve
Abductor pollicis brevis
Biceps reflex
C5/6
Flexion of elbow
Supinator (brachioradialis) reflex
C5/6
Flexion, Pronation or Supination of forearm
Triceps reflex
C7
Contraction of triceps
How do UMN lesions affect reflexes?
HYPERreflexia
Loss of disinhibition from higher brain centres which normally exert a degree of suppression over LMN reflex arc
How do LMN lesions affect reflexes?
HYPOreflexia
Loss of efferent + afferent branches of normal reflex arc
How does cerebellar disease affect reflexes?
Pendular: less brisk + slower in rise + fall
Light touch
Dorsal columns + Spinothalamic tracts
Crude touch
Spinothalamic tracts
Vibration
Dorsal columns
Proprioception
Dorsal columns
Mononeuropathy
localised sensory disturbance in the area supplied by the damaged nerve.
Peripheral neuropathy
symmetrical sensory deficits in a ‘glove + stocking’ distribution in the peripheral limbs. Causes: DM + chronic alcohol excess
Radiculopathy
nerve root damage (e.g. compression by a herniated intervertebral disc), resulting in sensory disturbances in associated dermatomes
Spinal cord damage
sensory loss both at + below level of involvement in a dermatomal pattern due to impact on the sensory tracts running through the cord.
Thalamic lesions
result in contralateral sensory loss.
Myopathies
symmetrical proximal muscle weakness.
Dysmetria
lack of coordination of movement- missing target by over/ undershooting
Intention tremor
broad, coarse, low-frequency tremor that develops as a limb reaches endpoint of a deliberate movement. Apparent as patient’s finger approaches yours.
What are dysmetria and intention tremor suggestive of?
Ipsilateral cerebellar pathology
List 6 cerebellar signs
Dysdiadochokinesia
Ataxia
Nystagmus
Intention tremor
Scanning speech
Hypotonia
