Upper limb PNS examination

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Presentation transcript:

Upper limb PNS examination

Introduction Wash hands Introduce yourself Confirm patient details – name / DOB Explain examination Consent Expose patient’s arms Ensure the patient is comfortable at rest

Inspection Tone Power Reflexes Coordination Sensation

1. Inspection Around the bed General appearance Scars Wasting Involuntary movements Fasciculations Tremor Pronator drift

2. Tone Wrist Forearm- pronation and supination elbow - flexion & extension *spasticity (“spastic catch”) shoulder - flexion/extension/abduction/adduction *leadpipe and cogwheel rigidity- Parkinson

3.Power Shoulder ABduction (C5) ADduction (C6/7) Elbow Flexion (C5/6) Extension (C7) Wrist Extension (C6) Flexion (C6/7) Fingers Finger extension (C7) Finger ABduction (T1) Thumb ABduction (C8/T1)

4. Reflexes Biceps reflex (C5/6) Triceps reflex (C7) Supinator reflex (C6)

5. Co-ordination 1. Finger to nose test *past pointing/dysmetria – cerebellar pathology 2. Dysdiadokinesia *slow irregular alternate movement- cerebellar ataxia/ Parkinson’s

6. Sensation Eyes closed Compare left to right Light touch- DC/ML pathway Pin-prick- spinothalamic pathway Propioception – DC/ML pathway Vibration - DC/ML pathway

Complete examination Wash hands Summary of findings Suggest further investigations (CN and LL neurological examination)