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 –
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tremor –
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drifting ( UMNL, cerebeller lessin, posteroir collomn loss )
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Feel –
muscle bulk and tenderess
Tone by moving all joints at slov velocity
Power –
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shoulder ( lift , abduction – C 5 6, adduction C 7 8)
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elbow ( flexion C 5,6 – extension – C7 C8 )
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wrist ( flexion – C 6 7 extension C 7 8 )
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FIngers ( flexion and extention both by C 7 8 , abduction and adduction – both by C8 T 1 )
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Check for Radial, median and ulnar nerve motor functions
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Reflexus –
Cordination – cerebeller –
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finger nose
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disdiabokynesis
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arms pushed up by holding
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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 )