Upper Neurological Exam

Question 1

how would you begin an upper neuro exam?

Answer 1

any pain or neck stiffness?
left or right handed?
inspect for any wasting, fasiculations, tremor, posture, scars
pronator drift (patient holds arm out for 20 seconds supinated with eyes close - look for signs of pronation)

Question 2

how would you test for tone in an upper neuro exam?

Answer 2

arm relaxed and hold patients hand + elbow whilst moving major joints passively
pronate and supinate arm
move wrist through full range of motion

Question 3

how would you test for power during an upper neuro exam?

Answer 3

shoulder -> abduct, adduct,
elbow -> flex, extend,
wrist -> flex, extend
thumb -> flex, extend, abduct, adduct, opposition

Question 4

how would you test for reflexes in an upper neuro exam?

Answer 4

biceps - thumb over biceps tendon + tap thumb
triceps - place forarm at 90 degree flexion and tap the triceps tendon
supinator - 4 inches from base of thumb

Question 5

how would you test for coordination in a upper neuro exam?

Answer 5

finger to own nose (+ w eyes closed)
touch thumb to each fingertip on same and rapidly
dysdiadochokinesis - palm of one hand to palm/back of other hand rapidly alternating

Question 6

how would you test for sensation in an upper neuro exam?

Answer 6

soft touch -> cotton wool + fingertip (use comparison point eg forhead)
pain/pinprick (describe)
temperature (describe)
proprioception -> distal thumb (up + down)
vibration sense -> interphalangeal joint of thumb can feel buzzing? when it stops?

Question 7

how would you test for cortical localisation in an upper neuro exam?

Answer 7

sterogenesis (identify a coin/key placed on patients hand with eyes closed)
graphaesthesia (identify a number being drawn on their palms)
2 point discrimination

Question 8

how would you complete an upper neuro exam?

Answer 8

lower limb neuro exam + full cranial nerve exam