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Flashcards in Upper Limb Exam Deck (13)
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1
Q

General inspection from end of bed of pt

A
  • any limb deformity or posturing
  • SWIFT: scars, wasting of muscle, involuntary movements (dystonua, chorea, myoclonus), fasciculations, tremor
  • ask pt to close eyes and place arms outstretched with palms facing up (look for pronator drift = UMN pathology)
2
Q

How do you assess tone?

A

Ask pt to let their arm go floppy

  • rotate wrist
  • supinate and pronate arm
  • move elbow and shoulder joints

Smooth, Dec tone = LMN
Inc tone = UMN

Feel for rigidity and cogwheeling = Parkinson’s

3
Q

How do you assess power in the shoulder?

A

Always compare each side when testing

  • put one hand on shoulder to stabilise joint
  • “put your arms up like a chicken and push against my arm” (abduction C5, adduction C6/7)
  • push down on one arm, then next
  • push up on one arm, then next
4
Q

How do you assess power in the elbow?

A

Stabilise elbow joint

  • put your arms up like a boxer and don’t let me pull your arm away/towards
  • flexion = C5/6, extension = C7
5
Q

How do you assess wrist power?

A
  • stabilise wrist joint
  • cock wrists back and push against my hand (extension C6)
  • flatten wrists and push down against my hand (flexion C6/7)
6
Q

How do you assess power in the fingers?

A
  • stabilise wrist joints
  • splay your fingers and don’t let me push them together (finger abduction T1)
  • point you’re thumb to the ceiling with palms up and push against my thumb (thumb adduction C8/T1)
  • squeeze my fingers as hard as you can (power grip)
  • make the on sign with your fingers and don’t let me pull them apart (opposition)
7
Q

What reflexes do you need to do?

A
  • biceps reflex (C5/6)
  • triceps reflex (C7)
  • supination reflex (C6): 4 inches proximal to base of thumb. Ask pt to wiggle their thumb and feel for the tendon
8
Q

How do you test for sensation?

A
  • get it to close eyes and ask them to say yes whenever they feel it
  • first test on pt sternum
  • test all dermatomes on upper limb, compare left to right
  • LIGHT TOUCH and PIN PRICK
  • offer to test temperature sensation using hot and cold
9
Q

How do you test vibration sensation?

A
  • ask pt to close eyes and tap a 128Hz tuning fork
  • test on pt sternum and make sure they can feel it
  • place it on DIP of forefinger and ask pt to report when they can feel vibration and when it stops
  • if vibration sense is impaired, continue to assess bony prominence of more proximal joints
10
Q

How do you test proprioception?

A
  • hold distal phalanx of thumb by its sides
  • demonstrate movement of thumb up and down to pt whilst they watch
  • ask the pt to close their eyes and state of you are moving the thumb up or down
  • move the thumb up/down 3 times on each hand
  • if it is unable to correctly identify direction of movement, move to a more proximal joint (finger, wrist, elbow, shoulder)
11
Q

How do you test coordination?

A

FINGER TO NOSE TEST:

  • ask pt to touch their nose and then your finger as quickly as they are able to
  • move your finger when pt is about to leave nose (moving target)

DYSDIADOCHOKINESIA:

  • ask pt to pat palm of one hand with palm and back of other hand as fast as possible
  • inability to do this suggests cerebellum ataxia/Parkinson’s
12
Q

How do you present it to examiner?

A
  • pt was clam and comfortable at rest and there was no paraphernalia of neurological disease
    EXAMINATION:
  • tone: normal on both sides
  • power: 5/5 on MRC scale in all muscle groups tested
  • reflexes: intact and normal in areas testes
  • coordination: normal, no evidence of dysdiadochokinesia
  • light touch and pain sensation were normal in all dermatomes tested
  • vibration sense and propriocetion were intact
13
Q

How would you finish the exam?

A
  • full history
  • cranial never and lower limb exam
  • GALS screen
  • further imaging if indicated (CT/MRI cervical spine)