- ? wasting, position, fasciculation or tremor
- hold arms out with palms up. Close eyes.
- ? slow drop - UMN weakness or fatiguability
- ? pronator drift - suggests contra-lateral pyramidal tract lesion (UMN)
- ? cerebellar lesion - push down and suddenly release; oscillates before returning to position
2) Tone - ? rigidity suggesting UMN lesion or extrapyramidal stiffness
3) Power
- "Can you make chicken wings and stop me pushing you down" = shoulder abduction
- "And stop me moving them up" = shoulder adduction
- "Bend your elbows and don't let me straighten them" = elbow flexion
- "And straighten them out" = elbow extension
- "Bend your wrist and don't let me straighten it" = wrist flexion
- "And try and straighten it out" = wrist extension
- "Now grip my finger" = finger flexion
- "Straighten your fingers and don't let me push them down" = finger extension
- "Try and spread your fingers out" = finger abduction
- "Keep this piece of paper between your fingers" = finger adduction
- "Move your thumb up" = thumb abduction
- "Hold this piece of paper between your thumbs and index fingers" = thumb adduction
4) Co-ordination - finger to nose
5) Sensation
Click here to view dermatomes
Click here to view areas innervated by nerve
6) Reflexes
- Suppinator = brachioradialis contraction = C5 and C6; mainly C6
- Biceps = C5 and C6; mainly C5
- Triceps = C7
Think about:
Median nerve palsy
Ulnar nerve palsy
Radial nerve palsy
Small print gem: Froment's sign = if adductor of thumb is paralysed, it flexes at the interphalangeal joint when testing thumb adduction with the paper between thumb and index finger test.
