Upper Limb Neurological Examination

The upper limb examination is another skill to elicit neurological signs i.e. nerve problems that supply the arms and hands.  Patients may present with a number of complaints including altered sensation e.g. pins and needles or numbness or loss of power of a limb, it may be intermittent such as multiple sclerosis or permanent such as in motor neurone disease.  Neuropathies can also occur and can be mono such as wrist drop or Erb’s palsy or poly such as “glove and stocking” which can occur in diabetes mellitus.

A full neurological examination therefore includes assessment of both the motor and sensory systems of the legs.  In exams you may be asked to focus on one part i.e. sensory or motor, however this guide will include both.

See Lower Limb Neurological Examination for how to perform this on the lower limbs.

Subject steps

  1. As with all examinations, the best method is your own – one with which you are comfortable and familiar. The one explained here takes the following format:

    • Tone
    • Power
    • Reflexes
    • Function
    • Sensation
  2. Begin by washing your hands, introduce yourself and clarify the patient’s identity.  Explain what you would like to do and gain the patient’s consent.

  3. Reflexes

    There are three reflexes in the upper limb – the biceps, triceps and supinator reflexes.

  4. Function

    To assess the upper limb, you should ask the patient to touch their head with both hands and then ask them to pick up a small object such as a coin which each hand.

  5. Sensation

    You should test light touch, pin prick, vibration, and joint position sense (proprioception).

  6. On completion, allow the patient to dress and thank them. Wash your hands and report your findings to the examiner.