1. Introduction
The upper limb neurological examination assesses the motor, sensory and reflex function of the cervical spinal cord, nerve roots, peripheral nerves and relevant cortical pathways. A structured sequence is essential.
2. Inspection and tone
With the patient seated, inspect for muscle wasting, fasciculation, asymmetry, involuntary movements, abnormal posture and splints or slings. Assess tone at the wrist, elbow and shoulder, encouraging the patient to relax.
3. Power
Assess power systematically using the MRC grading scale when relevant. Common muscle groups include shoulder abduction, elbow flexion and extension, wrist extension, finger abduction and thumb abduction. Compare both sides.
4. Reflexes and coordination
Assess biceps, supinator and triceps reflexes and compare side to side. Check coordination with finger to nose testing and rapid alternating movements. If upper motor neurone pathology is suspected, consider pronator drift.
5. Sensation and completion
Assess light touch over the dermatomes or key peripheral nerve territories, comparing side to side. To complete the examination, examine the neck, assess the lower limbs if an upper motor neurone lesion is suspected and consider cerebellar signs.
Preparation
Inspection
Tone
Power
Reflexes
Coordination
Sensation
Completion