Upper Limbs Exam

Question 1

What to look for on inspection of upper limbs

Answer 1

Scars
Wasting
Involuntary movements
Fasciculations
Tremor

Question 2

UMN pattern of weakness

Answer 2

Pyramidal pattern
Extensors in arms
Flexors in legs

Question 3

LMN pattern of weakness

Answer 3

Focal pattern of weakness

Question 4

What does pronator drift assess for?

Answer 4

UMN lesion
Contralateral pyramidal tract lesion
Supinators weaker than pronators

Question 5

Tone in UMN and LMN lesions

Answer 5

UMN: HYPERtonia
LMN: HYPOtonia

Question 6

Spasticity

Answer 6

Pyramidal tract lesion e.g. stroke
Velocity dependent
Faster you move the limb, the worse it is

Question 7

Rigidity

Answer 7

Extrapyramidal tract lesion e.g. PD
Velocity independent
Feels same regardless of how fast you move the limb

Question 8

What is cogwheel rigidity? In which condition is it seen?

Answer 8

Tremor superimposed on hypertonia resulting in intermittent increase in tone during movement
PD

Question 9

What is lead pipe rigidity? In which condition is it seen?

Answer 9

Uniformly increased tone throughout movement
Neuroleptic malignant syndrome

Question 10

MRC Grading scores

Answer 10

0 No contraction
2 Flicker/ trace of contraction
2 Active movement (without gravity) e.g. swimming pool or moving perpendicular to gravity e.g. left to right across bed but cant lift off bed
3 Active movement (against gravity)
4 Active movement (against gravity

Question 11

Shoulder ABduction

Answer 11

C5
Axillary nerve
Deltoid

Question 12

Shoulder ADDuction

Answer 12

C6/7
Teres Major, Latissimus dorsi, Pectoralis Major

Question 13

Elbow FLEXion

Answer 13

C5/6
Musculocutaneous + Radial nerve
Biceps brachii, coracobrachilais, brachialis

Question 14

Elbow EXtension

Answer 14

C7
Radial nerve
Triceps brachii

Question 15

Wrist FLEXion

Answer 15

C6/7
Median nerve
Flexors of the wrist

Question 16

Wrist EXtension

Answer 16

C6
Radial nerve
Extensors of the wrist

Question 17

Finger extension

Answer 17

C7
Radial nerve
Extensor digitorum

Question 18

Finger ABduction

Answer 18

T1
Ulnar nerve
First dorsal interosseous (FDI) + Abductor digiti minimi (ADM)

Question 19

Thumb ABduction

Answer 19

T1
Median nerve
Abductor pollicis brevis

Question 20

Biceps reflex

Answer 20

C5/6
Flexion of elbow

Question 21

Supinator (brachioradialis) reflex

Answer 21

C5/6
Flexion, Pronation or Supination of forearm

Question 22

Triceps reflex

Answer 22

C7
Contraction of triceps

Question 23

How do UMN lesions affect reflexes?

Answer 23

HYPERreflexia
Loss of disinhibition from higher brain centres which normally exert a degree of suppression over LMN reflex arc

Question 24

How do LMN lesions affect reflexes?

Answer 24

HYPOreflexia
Loss of efferent + afferent branches of normal reflex arc

Question 25

How does cerebellar disease affect reflexes?

Answer 25

Pendular: less brisk + slower in rise + fall

Question 26

Light touch

Answer 26

Dorsal columns + Spinothalamic tracts

Question 27

Crude touch

Answer 27

Spinothalamic tracts

Question 28

Vibration

Answer 28

Dorsal columns

Question 29

Proprioception

Answer 29

Dorsal columns

Question 30

Mononeuropathy

Answer 30

localised sensory disturbance in the area supplied by the damaged nerve.

Question 31

Peripheral neuropathy

Answer 31

symmetrical sensory deficits in a ‘glove + stocking’ distribution in the peripheral limbs. Causes: DM + chronic alcohol excess

Question 32

Radiculopathy

Answer 32

nerve root damage (e.g. compression by a herniated intervertebral disc), resulting in sensory disturbances in associated dermatomes

Question 33

Spinal cord damage

Answer 33

sensory loss both at + below level of involvement in a dermatomal pattern due to impact on the sensory tracts running through the cord.

Question 34

Thalamic lesions

Answer 34

result in contralateral sensory loss.

Question 35

Myopathies

Answer 35

symmetrical proximal muscle weakness.

Question 36

Dysmetria

Answer 36

lack of coordination of movement- missing target by over/ undershooting

Question 37

Intention tremor

Answer 37

broad, coarse, low-frequency tremor that develops as a limb reaches endpoint of a deliberate movement. Apparent as patient’s finger approaches yours.

Question 38

What are dysmetria and intention tremor suggestive of?

Answer 38

Ipsilateral cerebellar pathology

Question 39

List 6 cerebellar signs

Answer 39

Dysdiadochokinesia Ataxia Nystagmus Intention tremor Scanning speech Hypotonia