12 Steps Upper Limb Neurology Examination Checklist

No. Steps Tick

1. Expose Upper limb adequately
2. Inspection
 Always Compare both sides
 Inspect from shoulder  arms  forearms  hand
(a) Attitude / ‘position of rest’ (deformity)
(b) Muscle bulk and wasting (can measure) and Fasciculation (tap the muscle)
(c) Skin changes (café au lait), scars and wounds
(d) Look for upward or downward drifting: [ “Pronator Drift Test “ ]
- Stretch out both upper limbs straight with palm facing upwards and eyes
closed.
o If limb Drift upwards [Cerebellar lesion]
o If limb Drift downwards [Weakness. Primary Motor Lesion –usually stroke]
- Rebound phenomenon. **Ensure patient’s safety!
(e) Notice any involuntary movements… Resting tremors? [Parkinsonism]
Primary Motor component (UMN lesion vs LMN lesion)
3. - Tone [Hypertonia –Rigidity or spasticity? Hypotonia….?]
 Shake hands & Move all joints
o Slowness to release hand grip [Myotonic Dystrophy]
o Cog wheel rigidity [Parkinsonism]
o Lead pipe rigidity [stroke?]
o Clasp-knife spasticity [stroke?]
4. - Power
1. Start by asking patient to lift the upper limbs to the side by themselves. If
able, power is at least 3/5. (Also if examiner can prevent lifting, its 3/5)
o If not able  Ask patient to move without influence of gravity.
(Move UL left to right while supported by examiner)
o If able  Apply resistance.
Goal is to test the different groups of muscle:
 Shoulder joint – flexion, extension, abduction [C5] and adduction.
 Elbow joint – Flexion [C5 & C6] and extension [C7 & C8]
“5,6 pick up sticks, 7,8 lay them straight”
 Wrist joint – Flexion [C6] & Extension [C7]
 Finger joints – Extension [C8] & Abduction [T1]
5. - 3 Reflexes (1.Biceps, 2.Triceps and 3.Suppinator)
6. By the end, ask whether if this is a…..
 UMN lesion? (Tone? Power? Reflex(es)?)
 LMN lesion? (Tone? Power? Reflex(es)?)
7. Sensory Component [Localization of lesion by dermatomal testing.]
- Pain [lateral spinothalamic tract]
- Light touch [anterior spinothalamic tract]
- Vibration (start from most distal using 128Hz tuning fork [dorsal column]
8. By the end, ask whether if it is…
 Dermatomal distribution (Spinal level)?
 Glove and Stocking distribution (Peripheral neuropathy)?
 Single peripheral Nerve Injury?
Cerebellar
9. - Finger-to-nose test… Past pointing? [ also Intention Tremor..?]
10. - Rapid hand movement… Dysdiadochokinesia? [ 3D 2K]
- Proprioception
11. o Ask patient to close eye and test the distal interphalangeal joints
12. Proceed with peripheral nerve testing or lower limb neurological test (if needed)