Upper Limb Motor Examination Flashcards
6 parts of examination
What mneumonic can be used?
Inspection Tone Power Reflex Coordination Other tests
Inspection - what do you look for?
Mneumonic - SWIFT
What does hypomimia mean and what does it indicate?
Scarring Wasting Involuntary movements Fasciculations Tremor
Lack of expression
Parkinsons Disease
Inspection - Pronator drift:
- What do you get the patient to do?
- What does it suggest?
- What suggests a cerebellar lesion?
Pronator drift:
- have them extend arms
- palms up (suprinated)
- eyes closed
UMN on the contra lateral side
Contralateral pronation is stronger causing pronation +/- drift:
- Patients with a slight weakness in one arm won’t be able to keep the affected arm raised
- Ultimately the palm may begin to pronate
Contralateral arm may drift upwards
Tone
2 types of hypertonia?
Spasticity
Rigidity
Tone
What is spasticity?
What does it reflect?
Velocity-dependent hypertonia
The faster you move the limb, the worse it is. This is why you get the “spastic catch”
UMN lesion
Tone
What is rigidity?
What does it suggest?
How to accentuate rigidity?
General hypertonia throughout the range of movement (led-pipe) possibly with an underlying tremor (cogwheel)
Extrapyramidal disease - Parkinsonism - remember PD is in the brainstem!!
Get them to do task with other arm such as painting a wall or two out rhythm
Power
MRC scale 0-5: - define each stage
What does collapsing weakness mean?
0 - no contraction
1 - flicker or trace of contraction
2 - active movement but not against gravity (e.g. horizontal on surface)
3 - active movement vs gravity
4 - active movement vs resistance but less than normal
5 - normal power
CW - It is strong then gives way
Power
What movements do you test for at the:
- shoulders
- elbows
- wrists
- fingers
- thumb
Shoulder abduction and adduction
Elbow flexion and extension
Wrist flexion and extension
Finger extension and abduction
Thumb abduction
Power
What descriptors would you use to describe the power?
Mild, moderate, severe - could also use MDC
Bilateral or unilateral
Symmetrical or asymmetrical
Proximal
Distal
Global - all the muscles in a limb are affected equally
Pyramidial - originating from UMN lesion
Reflexes
What reflexes do we look for?
Biceps
Triceps
Supinator
Reflexes
What is hyperreflexia also known as and what does it indicate?
What does hyporeflexia indicate
Brisk reflexes
UMN lesions
LMN lesions
Reflexes
How would distract the patient to help elicit it?
What could you say if you don’t elicit any reflexes?
Distract them - clench teeth while you are doing it
Reflexes absent even with distraction
Coordination - what 2 things do you get them to do?
What is impairment of coordination also known as?
Finger to nose test
Rapid alternating movement with the hands
ataxia
Coordination
What suggests a cerebellar pathology? - D - 2
What could also cause finger to nose failure? - 2
Past pointing or dysmetria (over/under shooting)
Dysdiadochokinesia
Sensory ataxia (loss of proprioception) or weakness in the arm Parkinsonism
Function
Tests you can do for this
Pick up a pen
Do a button etc.
