Upper Limb Neurological Examination

Introduction0/5

• Greetings
• Hand wash
• Verify the patient's identity using at least two or three details
• Explanation
• Consent

Inspection0/4

• Posture
• Muscle wasting
• Skin changes
• Whether there are any equipment

• Pronator driftPosition patient sitting on bed edge. Ask to hold out both hands, palms up, arms extended, eyes closed for 30 seconds. Downward drift suggests UMN weakness, upward drift indicates cerebellar disease, searching movements of fingers suggest proprioception loss.
• ToneAsk the patient to relax. Assess for stiffness and rigidity in shoulder, elbow, and wrist.
  • Move shoulder, elbow and wrist while relaxed
  • Look for stiffness and rigidity
• Power (test symmetrically)Use MRC scale: 0 (no contraction) to 5 (normal power). For finger adduction, place paper between fingers and ask patient not to let go as you pull.
  • Shoulder Abduction (C5/6)
  • Shoulder adduction (C6/7/8)
  • Elbow flexion (C5/6), extension (C7/8)
  • Wrist flexion (C6/7), extension (C7/8)
  • Finger Abduction (T1)
  • Finger adduction (paper between fingers while pulling)
• Co-ordination
  • Exaggerated reboundPush down on outstretched arms and suddenly release. Look for excessive, uncontrolled upward movement.
  • Finger nose co ordinationAsk patient to touch nose, then your finger at arm's length. Repeat several times, moving your finger. Test both sides.
  • DysdiadochokinesiaAsk patient to tap palm then dorsum of one hand on the other, alternating as fast as possible. Look for poor coordination or slow movements.
• Sensation
  • Pain and temperatureUse pin. Demonstrate on sternum first. Start distally, work proximally, test each dermatome, compare sides.
  • Vibration and proprioceptionFor vibration, use tuning fork on DIPJ. For proprioception, move DIPJ up/down, patient reports direction with eyes closed.
  • Light touchUse cotton wool with dabbing motion. Start distally, work proximally, test each dermatome, compare sides.
    • C4
    • C5
    • C6
    • C7
    • C8
    • T1
• ReflexesClassification: absent, + (reduced), ++ (normal), +++ (increased). Use reinforcement (e.g., teeth clenching) if needed.
  • ElbowC5/6
  • TricepsC7/8
  • Supinator jerkBrachioradialis: C5/6
• Wash hands