UPPER LIMBS:

Wish The Examiners

Sanitize Your Hands

Greet The Patient

Look Around For Any Walkers, Modified Slippers, Orthotics

1.Expose Well Both The Upper Limbs

Check For Scars In Upper Limbs And Check For Scars In Scalp/Neck And Lower Back

2.Use Pillow To Support

3.Inspection-Muscle Bulk, Atrophy, Tremor And Scars Especially Around The Shoulder , Elbow And Wrist Joints

+Minds Protocol (Explained In Lowerlimb examination)

4) Ask The Patient To Stretch The Hands Out, Wrist Up( Dorsum Of Hand Up),

Then Ask The Patient To Raise The Hands, Outstretched With Palms Facing Up And

Ask Him To Close Eyes- Look For Pronator Drift

5)Ask The Patient To Hold The Hand With Palm Facing Down And Check For Pseudo Athetosis

6)A Quick Check For Hoffmans

-Tapping On Muscle Bulk For Checking For Fasciculations-Deltoid, Biceps, Triceps, Forearm

-Tone Across All Joints

–Power- Test Simultaneously Both Shoulders – Abduction, Adduction, Extension And Flexion( With Elbow Flexed). First Let The Patient Do It Against Gravity, Confirming Grade 3 Then Offer Resistance , Then Decide If Power Is Grade4 Or 5. Similarly Elbow- Flexion And Extension, Wrist Flexion, Extension, Then Hand Grip .

7) Reflexes-Biceps,Triceps,Supinator

8) Coordination – Finger Nose Testing And Dysdiadochokinesis

9) Sensations-(Reference Point Must)- Three Patterns Of Loss, Determine If Dermatomal, Glove And Stocking Or 

9)Patchy And Nonspecific Cotton Wool For Fine Touch Needle For Prick

10) Vibration – With 128/256 Hz Distal Most Bony Point Felt- Normal, If Not Ascend Upwards Until Vibration Felt.

11) Joint Position Sense- Distal Most Joint Movement , 10-15 Degrees Only, If Not Intact Ascend Upwards