UPPER LIMB NEUROLOGICAL EXAM

INTRODUCTION - WIPE REFLEXES

Wash Hands Patient Details Biceps Pt’s elbow b/w thumb C5, C6
Intro yourself Explain & Consent and finger
Tap on thumb directly
GENERAL INSPECTION - GRAM over tendon
Brachioradialis Pt to relax arm across C5, C6
abdomen
General appearance
Tap over supinator just
above wrist
Rashes – herpes zoster Triceps Arm across chest C7, C8
Asymmetry Tap on triceps tendon
Mental state Finger Grasp Pt’s slightly C8
flexed fingers
UPPER LIMB INSPECTION – SWIFT+P 0 = Areflexia (perform reinforcement manoeuvres)
SIGN PATHOLOGY 1+ = hyporeflexia
Scars Craniotomy scars 2+ = Normal
Wasting Neuromuscular disease 3+ = hyperreflexia without clonus
Involuntary Many including stroke, brain 4+ = hyperreflexia with clonus
Movements trauma, hypoxia etc.
COORDINATION
Fasciculations LMNL
Finger-Nose Test
Tremor Many e.g. Parkinson’s
• Testing for Finger-Nose Dysmetria
Pronator Drift UMNL • Pt to touch their nose, then your finger à repeat
o Slightly change position each time
MOTOR COMPONENT Past Point or Intention Tremor = Cerebellar Disease
TONE
Ask about joint pain Ask Pt to relax arms Alternative Movements
1. Shoulder • Pronate & supinate hand on palm of opposite hand as
2. Elbow quickly as possible
3. Wrist + clonus on wrist extension • Slow movements = Cerebellar Disease
Hypotonic, normal, hypertonic Dysdiadochokinesis

POWER SENSORY COMPONENT

Shoulder Abduction C5, 1. Light Touch – Cotton Wool
Adduction C6, C7, C8 2. Pain – Neurotip
Elbow Flexion C5, C6 3. Temperature – Tuning Form
Extension C7, C8 4. Vibration – Tuning Fork @ distal inter-pharyngeal joint
Wrist Flexion C6, C7 5. Proprioception – thumb
Extension C6, C7
Fingers Flexion + Extension C7, C8 1-3 = Spinothalamic Tract 4-5 = Dorsal Column Tract
Abduction/ T1
Adduction “Sensation normal in all modalities”
Power out of 5 “no signs of glove distribution neuropathy”
0 = paralysis “no signs of dermatomal sensory loss”
1 = flicker of contraction
2 = movement (gravity excluded) SENSORY:
3 = movement (against gravity, not against resistance) With the arm in the anatomical position (palm forward) draw a
4 = movement against moderate resistance line down the centre of the arm and cross the line at the elbow.
5 = normal The quadrants formed are therefore innervated as follows:
Lateral arm = C5
MOTOR: Lateral forearm, lateral hand, thumb and index finger = C6
1. Shoulder - muscles are innervated by FOUR NERVE ROOT Middle finger = C7
LEVELS (C5-C8), but asymmetrically i.e. abduction = C5 and Medial forearm, medial hand, ring and little finger = C8
adduction = C6, 7, 8 Medial arm = T1
2. Elbow - muscles are innervated by the SAME FOUR NERVE
ROOT LEVELS, but symmetrically i.e. flexion = C5,6 and
extension = C7,8

3. Thereafter, as one moves down one joint, one moves down one
nerve root level but each joint is only innovated by TWO NERVE
ROOT LEVELS i.e.:
At the wrist, both the flexors and extensors are in
innervated by C6 & 7.
At the MCPJ, both the flexors and extensors are in
innervated by C7 & 8.