1. Upper limb PNS examination

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

3. Inspection
Tone
Power
Reflexes
Coordination
Sensation

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

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

6. 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)

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

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

9. 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

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