1. Observe with the upper body undressed: nystagmus, Horner's syndrome, hemiplegia or wasting

2. Position maintenance. Get patient to stretch out arms with eyes closed look for drifting

3. Assess tone for hyper or hypotonia

4. Power
 

•     arm to the side (C5)
•     bending the elbows (C5,6)
•     push the elbows straight (C7)
•     squeeze the fingers ( C8, T1)
•     hold the fingers out straight (radial nerve, C7)
•     spread fingers apart (lunar nerve)
•     piece of paper between fingers (ulnar nerve)
•     thumb at ceiling (median nerve)
•     opposition of thumb and little finger (median nerve)

5. Co-ordination (finger-nose and rapid alternate movement for disdianochokinesia)

6. Reflexes: Bicep, triceps and Hoffman's signs

7. Sensation to light touch, pinprick, vibration and joint position
 

Most cases in upper limb examination have associated eye signs for example:
 

• hemiplegia in a patient with homonymous hemianopia
• wasting of small muscles of the hand in a patient with Horner's syndrome
• cerebellar signs in multiple sclerosis

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