Upper Limb Examination

Upper Limb 

Examination

Introduction:

• Introduction, correct patient, consent, wash hands (WINDEC); check for pain- can stop if painful

• Adequate exposure

Inspection:

• End of the bed- muscle wasting (dorsum hand), fasciculations; hands

• Tremor, pronator drift (palms upwards)

• Posture- kypho-scoliosis

Motor

Tone

• Assess rigidity- global movements

• Spasticity- fast rotation of wrist

Power

• Shoulder: 

  • • Abduction C5 - deltoid muscles, auxiliary nerve

    • Adduction C6,7,8- lat dorsi muscles, 

• Elbow

  • • Flexion C5/6- musculocutaneous, biceps

    • Extension C7- radial, triceps

• Wrist 

  • • Flexion C7, C8- musculocutaneous, 

    • Extension C6, C7- radial 

• Finger 3rd

  • • Extension: C7- radial 

    • Flexion: C8, medial + ulnar

    • Finger abduction T1- median

    • Finger adduction

• Thumb 

  • Abduction

  • Adduction T1- ulnar 

• Squeeze fingers

Reflexes

• Biceps C5/6

• Supinator C5/6

• Triceps C7

  • Arm across chest, consider reinforcement maneuvers- grit teeth (distraction

Co-ordination- both proprioception, motor and cerebellar integration

• Finger nose - option to do with eyes closed, also can detect intention tremor

• Dysdiadochokinesia- cerebellar lesion

Sensory

Fine touch

• Check sensation on sternum, hands anatomical; 

  • Lateral arm C5- can feel it, then same?

  • Lateral forearm C6

  • Lateral 2nd finger- C6, median nerve

  • Middle finger tip - C7, 

  • Medial palm of hand, ulnar nerve

  • Medial forearm, C8

  • Medial arm T1

• Glove distribution- move up, any change 

• Dorsal column

Sharp touch

• Same as fine touch; spinothalamic pathway 

Vibration

• Feel on sternum- sensation of buzzing, rather than metal

• Start distally on 2nd finger- eyes close, when stops

• If not sensation, move up joints: 2nd PIPJ, MCPJ, wrist, elbow, shoulder

• Dorsal column

Proprioception

• 2nd distal phalanx: up or down with eyes shut

• Move proximally to phalanx, finger, wrist, elbow, shoulder

• Dorsal column

Conclusion

Thank patient [name] for time, hand gel. 

Signs

Tone

• Led pipe rigidity- Neuroleptic Malignant Syndrome (NMS) 

• Cogwheel rigidity- Parkinson's Disease 

Conditions

Parkinson's Disease 

• Cogwheel rigidity, resting tremor

• Bradykinesia

• Shuffling gait, stooping posture, poor arm swing