Upper Limb Neurological Examination

            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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