Upper Limb

Question 1

1

Answer 1

“ive been asked to do an examination of your upper and lower limbs. its going to involve moving your arms and legs about a bit and testing the sensation”

For this im going to need you to take your top off if thats ok

Ask for their dominant hand

Question 2

2

Answer 2

inspect

im going to start by having a look at your arms

Scars wasting involuntary movements

Question 3

3
PRONATOR FOR UPPER
ROMBERGS AND GAIT (IF ASKED) FOR LOWER

Answer 3

PRONATOR DRIFT
hold hands out, palms facing DOWN whilst eyes closed

and keep eyes closed and turn them over … and hold it there

Question 4

4

Answer 4

tone

“just going to assess the tone in your arms so if you let your arms go floopy for me” meanwhile you hold hand and assess tone:

lift shoulder, bend elbow, bend wrist back and forth, turn writst,

Question 5

5

Answer 5

power

now going to test the strength of your muscles, if you could just pop your arms up like this for me”

“and dont let me push them down
and stop me from pulling them up”

SHOULDER:
Chicken wings - shoulder abd/add
Hands up straight - flexion
Hands down - extension

ELBOW (ext/flex/pron/supinate)
Boxer fist
Pronator and supinator against resistance

WRIST (flex/ext)
Cock wrist and cock them down

Question 6

5 Cont.

Answer 6

FINGERS (flex/ext/abd)
hands out straight, fingers together - push down (flexion)
fingers now flexed and

Abduction
(hold fingers)
index finger out
little finger out

THUMBS
Do in 3 directions - ABD, ADD and OPPOSITION
palms up thumb reaching ceiling
don’t let me push it down, up and across (opposition is pushing towards top of pinky)

Question 7

6

Answer 7

reflexes-

just going to assess your reflexes now, if you could let you arms go all floppy

bicep, tricep, supinator

( Bicep, tricep, wrist)

Question 8

7

Answer 8

Sensation - hands out like this for me

Im just going to test sensation on your arms now, im going to start by using some cotton wool, so im just goign to touch this on your chest. can you feel that? i want you to keep your eyes closed and tell me when you feel it by saying yes ok.
carry on to next

Question 9

8
ARMS AT 90, PALMS FACING UP

2 on outside of arm
2 on hand
2 on inside of arm

Answer 9

Outside of bicep 
Outside of forearm, 
Index, 
Flat palm 
Middle/inside of forearm
Inside of bicep

“did that feel the same on both sides”

Question 10

9

Answer 10

Vibration

Im now going to test your vibration sensation with this tuning fork. so its going to feel like this. can you feel that buzzing (put on chest). i want you to keep your eyes closed and just tell me when you can feel it buzzing ok.

Tell me when you can feel it buzzing (“yes”)…. and tell me when you feel it stop “yes”.

they did it on thumb on each hand

Question 11

10

Answer 11

Proprioception - THUMB
show them what youre doing, this is up, this is down…

Im now just going to move your fingers up and down. im just going to take your thumb. this is up, this is down. if you could close your eyes for me, im just going to move it up and down and i want you to tell me which. UP DOWN DOWN, each time taking it to the middle

do on both thumbs

Question 12

11

Answer 12

Coordination:

• fingers touching nose and finger
• finger to own nose with eyes ck

Question 13

12

Answer 13

Finger tips to thumb

Question 14

13

Answer 14

Dysdiadochokinesis

Question 15

14

Answer 15

Finish

“I performed an upper limb neurological examination on … on inspecting there were no scars, fasiculations, wasting, or involuntary movements noted. tone, power, reflexes were normal throughout and coordination was intact. sensation was normal.

to complete my examination:
cranial nerve exam, lower limb and inspect gait