Neurology Exam (Upper Limb)

Intro

Candidate introduces self with full name and role

Adheres to appropriate infection control measures

Asks patient if they are in any pain prior to beginning examination

Gains consent

Initial Inspection

Adequately exposes the patient

Identifies findings around the examination space

Comments on patients appearance from the end of the bed

Peripheral Exam

Inspects muscles for fasciculation, tremor, dyskinesia, & wasting

Motor

Performs screening movements

Tone - checks tone in the shoulder, elbow, and wrist (often done with a shaking the hand like grip)

Tone - checks for pronator drift

Rates power /5 for each joint level

Shoulder abduction (C5 + axillary nerve)
Biceps (C5)
Wrist extension (C6 + radial nerve)
Triceps (C7)
Finger flexors (C8)
Finger abduction (T1 + ulnar nerve)
Thumb abduction (T1 + median nerve)

Test upper limb reflexes

Biceps
Triceps
Brachioradialis

Sensory

Tests sharp/dull sensation with a neurotip

Tests light touch sensation with cotton wool

Tests vibration sense with a tuning fork

Tests proprioception

Offers to test temperature

Special Tests

Tests for dysdiadochokinesia with rapid alternating movement

Test coordination with finger-nose test

Complete Examination

Prompts patient to redress

Summarises by stating they would complete a full neurological exam including cranial nerves, review the patients notes, and offers to discuss with senior

Diagnosis and Interpretation

Requests appropriate investigation (Bedside, Bloods, Imaging, Special tests)

Gives appropriate differential

Management

Offers an appropriate management plan

Submit