Published on October 2nd, 2010 | by Lewis Potter
Upper Limb Neurological Examination – OSCE Guide
Upper Limb Neurological Examination frequently appears in OSCE’s. You’ll be expected to pick up the relevant clinical signs using your examination skills. This Upper Limb Neurological Examination OSCE guide provides a clear concise, step by step approach to examining the neurology of the upper limbs, with an included video demonstration.
Explain what you would like to examine
Expose arms & trunk
Ask if patient has any pain anywhere before you begin!
Signs around bed - wheelchair, walking stick, splints
General appearance – well/unwell
Muscle wasting - lower motor neurone lesion
Fasciculation - upper motor neurone lesion (i.e Multiple Sclerosis)
Tremor – parkinsons, benign essential tremor
Support the patients arm by holding their hand & elbow
Tell the patient to relax and allow you to fully control their arm
Move the arm’s muscle groups through their full range of movements
Is the motion smooth or is there some resistance (i.e led pipe rigidity)
Abduction – “Don’t let me push your shoulders down”
Adduction – “Don’t let me push your shoulders up”
Arms (biceps & triceps)
Flexion – “Don’t let me pull your arm away from you”
Extension - “Don’t let me push your arm towards you”
Extension - “Cock your wrists back & don’t let me pull them down”
Flexion - “Point your wrists downwards & don’t let me pull them up”
Finger Extension – “Put your fingers out straight & don’t let me push them down”
Finger Flexion – “Put your fingers out straight & don’t let me push them up“
Finger Abduction – “Splay your fingers & don’t let me push them together”
Finger Adduction – “Hold this paper between your fingers & don’t let me pull it out”
Thumb Abduction - “Point your thumbs to the ceiling and don’t let me push them down”
Thumb Adduction - “Don’t let me push you thumb away from your palm”
Get the patient to place there thumb & index finger together
Attempt to pull them apart
Get the patient to grip your fingers tightly
Attempt to remove your fingers from their grasp
If your fingers can easily escape it suggests an abnormally weak grip
Supinator (c6) - hyperreflexia, hyporeflexia?
Biceps (c5, c6) – hyperreflexia, hyporeflexia?
Triceps (c7) - hyperreflexia, hyporeflexia?
Soft touch (cotton wool) – cover the dermatomes & compare side to side
Sharp & Dull touch (neurotip) - cover the dermatomes & compare side to side
Vibration (128HZ) – test over bony prominence at base of the thumb
Proprioception – ask patient to close eyes – move finger- ask patient if it’s up or down
Pronator Drift – “close eyes & put your arms outstretched in front of you, palms facing up”
Finger to Nose – “touch your nose then my finger as fast as you can repeatedly”
Dysdiadokinesia - ask patient to rapidly pronate & supinate one hand on the back of the other
To complete the exam
Say you would…
Perform a full neurovascular examination of the upper limbs
Perform a full neurological examination if indicated..