Medically Fit For Exams
Medically Fit For Exams

Upper limb peripheral nerve examination

  • Wash your hands and introduce yourself
  • Check the patient’s name and DOB
  • Explain the examination and gain consent



  • Ask the patient to undress sufficiently to see the whole upper limb
  • Look for walking aids
  • Look for waster, hypertrophy or asymmetry
  • Look for abnormal movement, posture, fasciculations (especially in triceps)
  • Ask the patient to hold out both of their hand with palms up and close their eyes
  • Look for a ‘pronator drift’ – one hand starts to pronate and lower
    • Sign of upper motor neuron lesion



  • Ask the patient to relax their arm
  • Ask the patient if they have any pain in their shoulder
  • Take their hand in your hand, and place your other hand on their shoulder
  • Move their arm around including:
    • Elbow flexion
    • Supination, feeling for supination ‘catch’
    • Wrist circumduction, feeling for cogwheeling



  • Inform the patient that you are going to ask them to do some specific movements
  • In turn ask them to do the following, against resistance:
    • Put your arms out level with your shoulders like a chicken, and don’t let me push them down
    • Put your arm in front of you with your elbow bent like a boxer, and pull my hand towards you
    • Keep your arm in that position and push my hand away from you

Scale of muscle power


No movement


Flicker of movement


Movement only with gravity


Movement against gravity, but not resistance


Some movement against resistance


Full power against resistance

  •  Put your arms out straight with your wrists back and fists clenched, push against my hand (push from above and below, extending and flexing the wrist)
  • Squeeze my fingers as hard as you can
  • Spread your fingers out and don’t let me close them
  • Hold your palms upwards, with your thumb pointing towards the ceiling, don’t let me pull your thumb down



  • Biceps (musculocutaneous nerve, C5)
    • Ask the patient to rest their hand in their lap and relax their arm
    • Place your left thumb on the biceps tendon and hit with the tendon hammer
    • Observe for a flicker of the biceps or twitch of the hand
  • Triceps (radial nerve, C7)
    •  Stand behind the patient, bend their elbow to 90 degrees and hold it across their chest
    • Ask them to relax and let you take the weight
    • Hit the triceps tendon directly with the hammer
    • Observe for flicker of the triceps muscle, or movement of the forearm
  • Brachioradialis (radial nerve, C6)
    • Place a finger just proximal to the head of the radius (thumb side)
    • Ask the patient to relax
    • Hit your thumb with the tendon hammer
    •  Observe for flicker of the hand
  • Reinforce by clenching the teeth as necessary



  • Cerebellar rebound
    • Ask the patient to stand and hold their arms out straight in front of them
    • Tell them you are going to press down on their arms and let go, they need to bring their arms back to the original position
    • Observe for overshoot
  • Finger-nose test
    • Ask the patient to rapidly move their finger between their nose and your outstretched finger
    • Move your finger slightly between each attempt
    • Observe for intension tremor and missing of targets
  •  Dysdiadochokinesia
    • Ask the patient to hold one palm up, and with the other hand slap it with the palm and back of hand alternatively as quickly as possible



  • Light touch:
    •  Using a piece of cotton wool, touch the tip to the sternum as a reference
    • Ask the patient to close their eyes and say ‘yes when they feel the cotton wool’
    • Map down the limb in the dermatomes, switching between arms for comparison
    • Ask if it feels the same on each side
  • Pain:
    • Explain to the patient and use the neurotip to reference on the sternum
    •  Ask the patient to say ‘sharp’ or ‘dull’
    • As above
  • Proprioception
    • Ask the patient to close their eyes
    • Reference with movement of the interphalangeal joints
    • Pick one joint on each hand, flex or extend at random and ask the patient to say 'up' or 'down'

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