Upper limb neuro

Question 1

What are some types of abnormal involuntary movements seen in the upper limbs?

Answer 1

Tremor: Rhythmic oscillations caused by intermittent muscle contractions
* Tics: Paroxysmal, stereotyped muscle contractions, commonly suppressible, might be simple (single muscle group) or
complex. Temporarily suppressible.
* Myoclonus: Shock‐like, arrhythmic twitches. Not suppressible.
* Chorea: Dance‐like, unpatterned movements. Often rapid and may involve proximal or distal muscle groups.
* Athetosis: Writhing movements, mostly of arms and hands. Often slow.
* Dystonia: Sustained or repetitious muscular contractions, often produces abnormal posture.
* Hemiballismus: wild, large‐amplitude, flinging movements on one side of the body, commonly affecting proximal limb
muscles but can also affect the trunk.

Question 2

What does ‘tone’ mean in a neurological sense?

Answer 2

In skeletal muscle, ‘tone’ is a state of tension that is maintained continuously ‐ minimally even when relaxed ‐ and which
increases in resistance to passive stretch.

Question 3

What is the brachial plexus?

Answer 3

The brachial plexus is a somatic nerve plexus formed by intercommunications among the ventral rami (roots) of the lower
4 cervical nerves (C5‐C8) and the first thoracic nerve (T1).

Question 4

What abnormalities night you observe with the finger‐nose test for cerebellar function?

Answer 4

Clumsy and unsteady movements
* Finger may initially overshoot target, swinging side to side as it gets closer and finally reaches its target (difficulty
‘measuring’ = dysmetria)
* Intention tremor may also be present as the finger gets closer to its target
* Incoordination often worsens with eyes closed (suggesting position sense dysfunction)
* Consistent dysmetria to one side (= past pointing)

Question 5

What nerve roots are being tested for each reflex?

Answer 5

• Triceps C7 sometimes written as C6/C7, but is mainly C7
• Biceps C5/C6
• Brachioradialis C6
• Fingers C8

Question 6

What are the areas of the upper body that can test for each dermatome?

Answer 6

posterior aspect of the shoulders (C4)
* lateral aspect of the upper arms (C5)
* tip of the thumb (C6)
* tip of the middle finger (C7)
* tip of the pinky finger (C8)
* medial aspect of the lower arms (T1)

Question 7

What are some early symptoms of peripheral neuropathy?

Answer 7

The early symptoms of peripheral neuropathy include:
* Tingling
* Burning
* Pricking, stabbing, or shock‐like pain
* Muscle cramping
* Numbness
* Sensitivity to touch

Question 8

What 3 things are important to do when performing joint position sense?

Answer 8

Joint position sense tests the integrity of the ventral cerebellar tract. It is important to:
* Show the patient what ‘up and down’ of the joint will be and if they understand before proceeding with the test and then
ask the patient to close their eyes during the test
* Hold the joint by the lateral and medical aspects so as to avoid tactile cues by pressing on the nail
* Use small slow movements as the sensitivity of the test is inversely related to the velocity of the displacement