Neurological Examination of the Upper Limb

Introduction

This tutorial provides a systematic approach to performing a neurological examination of the upper limb. Understanding the key features that differentiate upper and lower motor neuron lesions is crucial for accurate diagnosis and treatment. This guide will walk you through the essential steps involved in the examination, highlighting important points and mnemonics to aid your learning.

Step 1: Preparation

Before starting the examination, ensure you have the right environment and materials.

• Environment: Choose a well-lit and quiet area for the examination.
• Materials: Gather necessary tools such as a reflex hammer, tuning fork, and any other instruments required for the neurological assessment.
• Patient Interaction: Explain the procedure to the patient to gain their consent and cooperation.

Step 2: Inspection

Begin with a visual assessment of the upper limb.

• Look for Deformities: Check for any visible abnormalities or asymmetries in the limbs.
• Skin Condition: Observe the skin for any signs of lesions, discoloration, or atrophy.
• Posture and Movement: Assess the resting position of the hands and arms.

Step 3: Tone

Assess the muscle tone of the upper limbs.

• Technique: Gently move the patient’s arm at the elbow and wrist to evaluate resistance.
• Types of Tone:
  • Normal: Some resistance, but not excessive.
  • Increased Tone: May indicate upper motor neuron lesions (spasticity).
  • Decreased Tone: Suggestive of lower motor neuron lesions (flaccidity).

Step 4: Power

Test the muscle strength of the upper limb.

• Grading Scale:
  • 5/5: Normal strength.
  • 4/5: Slight weakness.
  • 3/5: Movement against gravity but not resistance.
  • 2/5: Movement with gravity eliminated.
  • 1/5: Flicker of movement.
  • 0/5: No movement.
• Specific Tests:
  • Test specific muscle groups and document findings.

Step 5: Reflexes

Evaluate the reflexes of the upper limbs.

• Key Reflexes to Test:
  • Biceps Reflex: Tap the biceps tendon and observe for contraction.
  • Triceps Reflex: Tap the triceps tendon to assess.
  • Brachioradialis Reflex: Tap the radial artery area.
• Scale: Use the same grading scale as for power (0 to 4+).

Step 6: Co-Ordination

Assess the coordination of the upper limb.

• Finger-Nose Test: Ask the patient to touch their nose and then your finger.
• Rapid Alternating Movements: Have the patient rapidly alternate touching their palm and back of the hand.

Step 7: Sensation

Evaluate the sensory function of the upper limbs.

• Types of Sensation to Test:
  • Light Touch: Use a cotton swab or fingertip.
  • Pain: Use a pinprick to assess sharp sensation.
  • Temperature: Use a tuning fork or cold object.
  • Proprioception: Move the patient's finger and ask them to identify the position.
• Comparison: Always compare sides for any asymmetry.

Step 8: Concluding the Examination

Wrap up the examination with a summary and next steps.

• Document Findings: Record all observations and results for further analysis.
• Communicate with the Patient: Discuss any immediate concerns or follow-up steps required.

Conclusion

Conducting a thorough neurological examination of the upper limb is essential for identifying motor and sensory deficits. By systematically following these steps, you can ensure a comprehensive assessment. Remember to practice regularly to refine your skills and improve your diagnostic abilities. For additional resources, consider reviewing related videos or materials on neurological assessments.