UPPER LIMB. Examination of strength of upper lomb pptx

Upper limb

1. Examination of strength of upper limb : First year MBBS

2. Table of content: Introduction Examination Inspection Palpation Movements: Function Special test Complete Examination

3. Introduction Introduction Wash your hands  and  don PPE  if appropriate. Introduce yourself to the patient including your  name  and  role . Confirm the patient’s  name  and  date of birth . Briefly  explain  what the examination will involve using  patient-friendly   language . Gain consent  to proceed with the examination. Adequately  expose  the  patient’s arms  for the examination from the shoulders to the hands.

4. Position  the patient appropriately (either sitting on the side of the examination couch or lying at 45°). Ask the patient if they have any  pain  before proceeding with the clinical examination

5. General inspection: Inspection: To have a look: Scars:  may provide clues regarding previous spinal, axillary or upper limb surgery. Wasting of muscles:  suggestive of lower motor neuron lesions or disuse atrophy. Tremor:  there are several subtypes including resting tremor and intention tremor.

6. Pronator drift Assessment Checking for pronator drift is a useful way of assessing for mild upper limb weakness and spasticity: 1.  Ask the patient to hold their arms out in front of them with their palms facing upwards and observe for signs of pronation for 20-30 seconds. 2.  If no pronation occurs, ask the patient to close their eyes and observe once again for pronation (this typically accentuates the effect due to the reliance on proprioception alone).

7. Interpretation Pronator drift involves both pronation (rotation of the forearm/wrist from palm up towards a palm down position) and downward movement of an upper limb (i.e. drift). The presence of pronator drift indicates a contralateral corticospinal tract lesion. Pronation occurs because, in the context of an UMN lesion, the supinator muscles of the forearm are typically weaker than the pronator muscles.

8. Palpation: Tone Assessment Assess tone in the muscle groups of the  shoulder ,  elbow  and  wrist  on each arm, Feel for abnormalities of tone as you assess each joint (e.g. spasticity, rigidity, cogwheeling, hypotonia).

9. Assess power using MRC scale: MRC muscle power assessment scale Score Description No contraction 1 Flicker or trace of contraction 2 Active movement, with gravity eliminated 3 Active movement against gravity 4 Active movement against gravity and resistance 5 Normal power

10. Movements: Movements around shoulder involve: Shoulder Abduction Shoulder Adduction Flexion of shoulder joint Extension of shoulder joints Internal rotation of shoulder joints External rotation of shoulder joinys

11. Shoulder Abduction

12. Shoulder Adduction

13. Shoulder Flexion and extension

14. Internal rotation of shoulder joint

15. External rotation

16. Elbow joint: Movements around the elbow joints Supination Pronation Elbow flexion Elbow extension Adduction Abduction

17. Elbow extension

18. Elbow flexion

19. Supination and pronation of arm

20. Wrist joint: Wrist joints movement include : Wrist extension Wrist flexion Wrist abduction Wrist Adduction

21. wrist Flexion

22. Wrist extension

23. Finger Abduction Fan out your finger

24. Finger Adduction

25. Finger Extension

26. Finger flexion

27. Thumb Abduction

28. To complete the examination Thank the patient for their time.
Dispose of PPE Appropriately and wash your hands. Summarise your findings.