Neuro - Upper Limb

Question 1

What must be done during inspection (UL Neuro)?

Answer 1

• General inspection
  
  • pt
  • bedside
• Closer inspection
  
  • Tremors
  • muscle wasting – thenar/hypothenar wasting, dorsal hand guttering (LMN lesion),
  • fasciculations (LMN lesion)
  • Skin: neurofibromas, café au lait spots, scars (including small muscle biopsy scars)

Question 2

How do you test muscle tone (UL Neuro)?

Answer 2

Question 3

What does 1-5 in MRC power grading mean?

Answer 3

MRC grades:

5 = full power,

4 = some resistance,

3 = GRAVITY,

2 = gravity eliminated,

1 = flicker of muscle contraction,

0 = nothing.

Question 4

How do you test muscle power (UL Neuro)?

Answer 4

Question 5

How do you test reflexes (UL neuro)?

Answer 5

 Biceps (C5/6): Ask patient to relax their arm across their lap. Place your index finger across their biceps tendon and then strike your finger.

 Supinator (C4/6): With the patient’s arm still relaxed across their lap, place your index and middle finger over the brachioradialis tendon and strike your fingers.

 Triceps (C7): Hold their ipsilateral wrist with one hand while they let their arm go floppy. Strike their triceps tendon with the tendon hammer.

Question 6

What are the possible finding when testing reflexes?

Answer 6

Brisk (present)

Normal (present)

Reduced (present)

Absent

Question 7

How do you test coordination (UL neuro)?

Answer 7

Question 8

How do you test sensation (UL neuro)?

Answer 8

• Pain (spinothalamic): use neurological pin
  
  • “Close your eyes and every time you feel it say ‘sharp’ if it feels sharp like it did on your sternum or ‘blunt’ if it feels blunt”
• Light touch (dorsal column): use cotton wool bud
  
  • “Close your eyes and every time you feel it say ’yes’”
• Proprioception (dorsal column)
• Vibration (dorsal column) - 128Hz tuning fork
• Temp. (spinothalamic) - 128Hz tuning fork - cold

Question 9

What is the presentation of:

a) UMN lesion
b) LMN lesion

Answer 9

see image