Upper Limb exam

Question 1

Introduction

Answer 1

1. Wash hands
2. Introduce
3. Patient details
4. Permission: Today I have been asked to perform an examination of the nerves in your arm - this will involve me having a look, a feel and a move of your arm. We have our examiner here as chaperone. Does that sound okay?
5. Exposure - shoulder to hand
6. Reposition - 45 degree
7. Any questions? Any pain?

Question 2

General inspection

Answer 2

Scars
Wasting
Involuntary movements
Fasciculations
Tremor

PRONATOR DRIFT - hold hands in front with palms to air, close eyes and assess for pronation (30 secs)

Question 3

Tone

Answer 3

Shoulder
Elbow
Wrist and hand

Question 4

Power

Answer 4

Shoulder
Elbow
Wrist
Finger and thumb

Question 5

Reflexes

Answer 5

Biceps (C5/6)
Triceps (C7/8)
Supinator (C5/6)

Question 6

Sensation

Answer 6

C4: over the acromioclavicular joint.
C5: the lateral aspect of the lower edge of the deltoid muscle (known as the “regimental badge”).
C6: the palmar side of the thumb.
C7: the palmar side of the middle finger.
C8: the palmar side of the little finger.
T1: the medial aspect antecubital fossa, proximal to the medial epicondyle of the humerus

Light, sharp

Question 7

After sensation

Answer 7

Vibration (128Hz)
Proprioception

Question 8

Coordination

Answer 8

Finger to nose
Dysdiadochokinesia

Question 9

To conclude

Answer 9

THANK, WASH HANDS
To conclude - full neuro (LL, CN), upper limb MSK, vascular)