Upper Limbs

Question 1

What are the steps of the upper limb examination?

Answer 1

1. Observation
2. Tone
3. Power
4. Co-ordination
5. Reflexes
6. Sensation

Question 2

What are you looking for in observation?

Answer 2

1. Muscle atrophy
2. Fasciculations
3. Skeletal deformity
4. Scars
5. Tremor
6. Involuntary movements

Question 3

What are two commonly found tremors?

Answer 3

• Physiological
  
  • Fine, fast upper limb tremor
  • Caused by anxiety, hyperthyroidism, alcohol excess and some drugs
• Parkinsonian
  
  • Slow, coarse, greater at rest, mostly upper limbs and usually symetrical

Question 4

What are examples of involuntary movements?

Answer 4

• Dystonia
  
  • Sustained muscle contractions which are twisting and repetative
• Chorea and athetosis
  
  • Writhing movements
• Ballismus
  
  • Violent flinging movements
• Ticks
  
  • Repetitive and stereotyped

Question 5

What can tone be?

Answer 5

• Increased
  
  • Hypertonia
• Decreased
  
  • Hypotonia

Question 6

What are the 2 main types of hypertonia?

Answer 6

• Spasticity
  
  • Velocity dependent resistance to passive movements, increased joint varies throughout whole movement
  • Feature of UMNL
• Rigidity
  
  • Sustained resistance even when slow movement, present throughout whole movement

Question 7

What nerve roots are the following reflexes:

• biceps
• suppinator
• triceps

Answer 7

• Biceps
  
  • C5/6
• Triceps
  
  • C7
• Supinator
  
  • C6

Question 8

How can power be graded?

Answer 8

• MRC scale 0 to 5
  
  • 0 no contraction
  • 1 visible muscle contraction but no limb movement
  • 2 active movement but not against gravity
  • 3 active movement against gravity
  • 4 active movement against gravity and little resistance
  • 5 full power against full resistance

Question 9

What is done to test sensation?

Answer 9

Light touch

Pinprick (pain)

Vibration

Proprioception

Question 10

What tract carries:

• fine touch, properioception and vibration
• pain and temperature

Answer 10

• Fine touch, proprioception and vibration
  
  • Dorsal column
• Pain and temperature
  
  • Spinothalamic tract

Question 11

How are reflexes recorded?

Answer 11

+, ++, +++. _ or +/-

Question 12

What is done for sensation lower limbs?

Answer 12

• Light touch
• Pinprick
• Vibration
• Properioception, including Romberg’s test

Question 13

What are you looking at in gait?

Answer 13

• Leg movements
• Posture
• Presence or absence of arm swing

Question 14

What does the following test:

• walking and turning
• heel to toe
• rising from sitting
• on tiptoe and heals

Answer 14

• Walking and turning
  
  • Gait
• Heel to toe
  
  • Balance
• Rising from sitting
  
  • Lower limb power
• TIptoe and heels
  
  • Distal limb power

Question 15

Compare UMN and LMN signs for following:

• fasciculation
• pronator drift
• tone
• power
• reflexes

Answer 15

Question 16

What pattern of weakness does LMN and UMN cause?

Answer 16

• LMN
  
  • Focal pattern, only muscles directly innervated by damaged neurons
• UMN
  
  • Pyramidal pattern, extensors and wekaer than flexors in upper limb