get the patient to sit on the edge of the bed – 
inspect the upper limbs – and shoulder – 
 – swelling, scar, skin chanegs and wasting + deformity – 
– wasting and fasciculations are important – 
 
put the arms straight up – with palms up – stand 
look for – 
    • tremor – 
    • drifting ( UMNL, cerebeller lessin, posteroir collomn loss ) 
Feel – 
muscle bulk and tenderess
Tone by moving all joints at slov velocity 
 
Power – 
      • shoulder ( lift , abduction – C 5 6, adduction C 7 8) 
      • elbow ( flexion C 5,6  – extension – C7 C8 ) 
      • wrist ( flexion  –  C 6 7         extension C 7 8 ) 
      • FIngers  ( flexion and extention both by C 7 8 , abduction and adduction – both by C8 T 1 ) 
      • Check for Radial, median and ulnar nerve motor functions  
 
 Reflexus – 
 
 
Cordination – cerebeller – 
      • finger nose 
      • disdiabokynesis 
      • arms pushed up by holding 
Sensory examination – 
look for scars 
Pain and temperature first – by pin ( sharp )  – each dermatome – and then each nerve – 
        ( can check by blunting it ) 
Vibration – 128 hz  – ( first on chest ) – tell when he can feel it – and say when it stops _ start at base of thimb- if normal, no need further ( if absent – come up to sholder ) 
propioception of index finger distl  phalanx
Then to light touch ( to not stroke the cotton ) 
 
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