Upper Limb Neurology Examination Flashcards
On general inspection looking for:
Patient posture, habitus & other signs of neurological conditions e.g. hypomimia & facial muscle wasting
Around bed: mobility aids & orthoses
Local inspection looking for:
Tremors
Muscles: look in general then look for thenar/hypothenar wasting, dorsal hand guttering (LMN lesion) and fasciculations (LMN lesion)
Skin: neurofibromas, cafe au lait spots, scars including small muscle biopsy scars
Dorsal hand guttering and fasciculations are signs of what kind of lesion?
LMN
Pronator drift and distal flexion is a sign of?
Pyramidal weakness
Upward drift of outstretched arms is a sign of?
And is accentuated by?
Cerebellar pathology
“Rebound” - pushing patients wrists down briskly and quickly letting go
Shoulder abduction tests which nerve root?
C5 - deltoid
Elbow flexion tests which nerve root?
C6 - brachioradialis
Elbow extension tests which nerve root?
C7
Wrist extension (dorsiflexion) tests which nerve root?
C7 - wrist extensors
Wrist flexion (palmar/volar flexion) tests which nerve root?
C7
Finger extension tests which nerve root?
C7 C8 - long extensors
Finger flexion tests which nerve root?
C8 - long flexors
Finger abduction and thumb abduction tests which nerve root?
T1
Conditions causing a positive prayer sign? (cannot flatten hands)
“put your palms together and push your elbows outwards”
Rheumatoid arthritis Scleroderma Diabetes - cheiro-arthropathy Ulnar nerve palsy - partial claw hand T1 palsy - complete claw hand Dupytren's contracture
Pincer grip tests which muscle & nerve?
Adductor policis - innervated by the ulnar nerve
