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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