1-

2-

Introduction:

a.

Wash hands

b.

Introduce yourself

c.

Check patient details name / DOB

d.

Explain what youd like to examine

e.

Gain consent

f.

Expose patients arms fully

g.

Ask if the patient has any pain anywhere before you begin

Inspection

a.

Shake hands with the patient and see if the pnt cannot relax his/her hand grip this indicates myotonia

b.

Observe for clues around the bed wheelchair / walking stick etc

c.

General appearance any limb deformity or posturing?

i. Scars
ii.

Wasting of muscles

iii.

Involuntary movements dystonia, chorea, myoclonus

iv.

Fasciculations: relax the patient arm on his lap.

v. Tremor parkinsons disease / benign essential tremor

vi.
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4-

Posture

Pronator drift:

a.

Ask patient to close eyes & place arms outstretched THEN your palms facing up

b.

Observe the hands / arm for signs of pronation

c.

If pronation occurs in one of the arms, it indicates UMN pyramidal pathology

Tone
a.

Ask the patient to let their arm go floppy, whilst you move each major joint
i. Support the patients arm by holding their hand & elbow
ii.

Move the wrist through its full range of motion 360

iii.

Pronate & supinate the forearm

iv.

Flex & extend the elbow joint feel for any spasticity (spastic catch)

v.Flex/extend/abduct/adduct the shoulder joint

b.

Note the character of the movement smooth / tone/ tone (flaccid)

c.

Feel for rigidity & cog-wheeling indicative of Parkinsons disease

i. Here ask the ptn to move arm up and down as you move the hand and forearm bcz the rigidity in those ptns induced by
movement

5-

Power
a.

Assess power one side at a time & compare between sides

b.

Remember to stabilise & isolate the joint when testing

c.

Shoulder

i. Abduction (C5) Dont let me push your shoulders down

ii.
d.

Adduction (C6/7) Dont let me pull your arms away from your sides

Elbow

i. Flexion (C5/6) Dont let me pull your arm away from you
ii.
e.

Extension (C7) Dont let me push your arm towards you

Wrist

i. Extension (C6) Cock your wrists back & dont let me pull them down
ii.
f.

Flexion (C6/7) Point your wrists downwards & dont let me pull them up

Fingers

i. Finger extension (C7) Put your fingers out straight & dont let me push them down
ii.

Finger flexion: ask the ptn to squeeze your finger

iii.

Finger abduction (T1) Splay your fingers & dont let me push them together
1.

First dorsal interosseous (FDI)

2.

Abductor digiti minimi (ADM)

iv.
Thumb abduction (C8/T1) Point your thumbs to the ceiling and dont let me
push them down
g.
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*SEE RAPID SCREEN TABLE AT THE END FOR A QUICK WAY TO TEST NERVES

Reflexes:
a.

For each of the reflexes, ensure the patients upper limb is completely relaxed

b.

Place your finger over tendon being assessed & strike with the tendon hammer
i. Biceps reflex (C5/6) located in the cubital fossa
ii.
Triceps reflex (C7) place forearm rested at 90 flexion tap your finger
overlying the triceps tendon
iii.

7-

Supinator reflex (C6) located 4 inches proximal to base of the thumb

Coordination:
a.

Finger nose test

b.

Rapid alternating movement

c.

Rebound test