An example of a perfect upper limb neurology examination for OSCE/ISCEs for medical students, or in clinical practice for junior doctors. Step-by-step guide covering a neurological examination.
Upper Limb Neurological Examination
4. Reflexes
May present with: - Supinator (c5/c6)
Altered gait, weakness, paralysis, sensory deficits, ataxia, posturing, Hit fingers along imaginary line on forearm from thumb
tremor, paraesthesia
- Biceps (c5/c6)
W.I.P.E.E Hit fingers placed in crook of elbow
- Sitting up
- Exposure = waist up, ideally no bra, but could be t-shirt - Triceps (c7)
Superior to posterior elbow
1. Inspection
Remember S.W.I.F.T! 5. Coordination
- Scarring, symmetry Test of cerebellar function – D.A.N.I.S.H.
- Wasting
Dysdiadochokineasia (past pointing)
- Involuntary movements
Ataxia (wide base gait)
- Fasciculations Nystagmus (lateral eye movement)
- Tremors Hypertonia
Hyperreflexia
2. Tone
- Hold hand of patient in a similar way you’d shake - Finger-nose test (both hands)
their hand and go through all movements - Flip hand over in other hand (both hands)
1) Flex fingers - Oppose all fingers to thumb
2) Flex and extend wrist
3) Flex and extend elbow
4) Flap arms at side
6. Sensation*
- Pain (neurotip)
- Normal, increased, decreased? - Light touch (cotton)
- Spasticity (clasped knife resistance – no movement - Temperature (cold metal tuning fork)
at first then gives way to force), flaccidity Spinothalamic pathway
(decreased tone), rigidity (cogwheel or lead-pipe
resistance – not velocity dependent) - Proprioception (close eyes and move finger)
- Vibration (tuning fork)
Dorsal column pathway
3. Power
- Grade out of 5
0 = no visible muscle contraction
1 = flicker of contraction, no movement Further investigations
2 = joint movement when gravity eliminated - Full medical history
3 = movement against gravity - Full neurovascular examination upper/lower
4 = movement against resistance, but weak - Nerve conduction studies
5 = normal
- CT/MRI
- ‘arms out like a chicken’ – don’t let me push down
- ‘arms up like a boxer’, don’t let me push them in (C7
– tricep = elbow extensors) / pull them out (C5 – bicep =
elbow flexors)
- ‘bend your wrists back’ – don’t let me push them
down (C6 – wrist extensors)
- ‘wrists down’ – don’t let me pull them up
- ‘make a fist and squeeze my fingers’ – (C8 – finger
flexors)
- ‘spread your fingers’ – don’t let me push them in (T1
– finger abductors – test little finger)
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller PassMedSchool. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for £3.49. You're not tied to anything after your purchase.
