Upper Limb Neurological Examination

Equipment

  1. Tendon hammer

  2. Neurotip

  3. Cotton wool

  4. Tuning fork (128Hz)

Introduction

 

  • Wash hands with alcohol gel

  • Introduce yourself to patient

  • Confirm patients name and date of birth

  • Obtain consent to examine the patient and explain what this will involve

  • Ask for a chaperone if required

  • Position patient – sit in chair or 45 degrees on table, ensure arms are exposed

  • Ask the patient if they have any pain

  • Gather equipment 

 

Inspection

  • Look at end of bed for patient – walking stick, catheter, wheelchair

  • General appearance

    • Abnormal posturing

    • Fasciculations

    • Involuntary movements

    • Paralysis

    • Tremor

  • Inspect muscles for size, shape and symmetry

  • Assess for pronator drift – ask patient to hold out arms in front of them with palms up and eyes closed

  • If pronation of one arm suggests upper motor neuron pathology

 

Tone

Assess tone for each major joint

Assess for hypotonia, spasticity, rigidity