Upper Limb Exam

Ask The patients .....

• 1. pain /stiffness of joint ,muscle or bone .
• 2. History of arthritis 
• 3. Dress himself / herself without difficulty 
• 4. can walk up and downstairs 

Look : 

• 1. Any swelling of joint .
• 2. Skin color .
• 3. Active movement : movement of joint by the patient himself or herself .
• 4. Any Deformities .
• 5. Visible muscle wasting 
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  Feel : 

  
  
  • 1. Local Temperature
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  • 2. Tenderness: 
  • Grading of tenderness: 
  • Grade-1:- patient says the joint is tender .
  • Grade-2 : the patient winces/grimace 
  • Grade-3:- the patient winces & withdraw the affected part .
  • Grade-4;- the patient will not allow touching the affected part .
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  • 3. Measuring the muscle wasting .
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  • 4. Joint effusion 
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  • 5.Passive movement of joint ( by eximaner’s hand)
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  • 6. Stability of joint 
  
  
  
  

  • Move :

    
    
    • 1. Examine the range of movement of all joint 
    • 2. Passive movement 
    • 3. Active movement – to see the power of joint 
  
  
  
  

Neurological Part :

1). Bulk of muscle: 

Comment: Normal / Diminished/ increased 

a. Inspection : compare both sides or to examiners corresponding part .

b. palpation: 

wasted muscle are not only smaller but also softer and more flabby when contated . Measure tap in both side in marked bony prominence . 

site: arm /calf/ leg 

Causes of muscle atrophy : 

• a. wasting diseases
• b. injury or diseases of joint 
• c. Lower motor neuron lesion 

Causes of muscle hypertrophy : 

• a. Functional 
• b. genetical 
• c. Duchenne muscular dystrophy 

2. Tone of muscle :

Tell the patient, ‘Keep your limbs relaxed’. Now the examinee should do the

following—

•  Lift the leg and allow it to fall.
•  Palpate the muscle and perform side to side movement of the limbs.
•  Lastly, passive movement of the limb (in irregular fashion—flexion and extension).

3.Test for clonus (ankle and patella). 

4. Muscle power (against resistance): If any weakness, mention grading of weakness. To test, ask

the patient to follow your instructions as follows:

Grading of muscular weakness, Medical Research Council (MRC) criteria:

•  Grade 0: Complete paralysis.
•  Grade 1: A flicker of contraction only.
•  Grade 2: Power detectable, when gravity is excluded by postural adjustment.
•  Grade 3: Limb can be held against gravity, but not against examiner’s resistance.
• Grade 4: There is some degree of weakness.
• Grade 5: Normal power.