med study partner

All examinations

Neurological Examination – Upper Limb

Source-faithful checklist for the neurological examination of the upper limb.

Neurology · Self-paced

Step 1. Introduction

  1. Hand hygiene

    Hand wash/rub

  2. Introduce yourself

    Introduce self

  3. Explain the purpose

    Explain purpose

  4. Consent

    Obtain consent

  5. Pain or limitation

    Ask if patient has pain or limitation of movement

Step 2. General Inspection

  1. Orientation

    Orientation

  2. Comfort or distress

    Comfort/distress

  3. Posture

    Posture

  4. Wasting

    Wasting

  5. Tremor

    Tremor

  6. Fasciculations

    Fasciculations

  7. Skin changes

    Skin changes

  8. Report findings

    Report findings correctly

  9. Vital signs

    Comment on vital signs

Step 3. Tone, Drift and Active Movement Screening

  1. Drift

    Assess drift

  2. Active voluntary movements

    Inspect active voluntary movements (screening)

  3. Tone

    Assess tone (passive movements)

  4. Compare sides

    Test both sides and compare

  5. Report findings

    Report findings correctly

Step 4. Power

  1. Shoulder abduction

    Shoulder abduction (C5)

  2. Elbow flexion and extension

    Elbow flexion (C5, C6) and extension (C7, C8)

  3. Wrist extension and flexion

    Wrist extension (C6) and flexion (C7)

  4. Finger extension and flexion

    Finger extension (C7) and flexion (C8)

  5. Grip strength

    Grip strength (T1 for finger flexion, C6 for partial wrist extension)

  6. Finger movements

    Finger abduction (T1), finger adduction (T1), opposition of thumb and little finger (T1)

  7. Thumb movements

    Thumb flexion, extension, abduction, adduction (all T1, except extension – radial nerve, C7)

  8. Compare sides

    Test both sides and compare

  9. Report findings

    Report findings correctly

  10. Myotome assessment limitation

    Students should know (but need not report) which myotome is tested with each movement; may be tested in written exam.

Step 5. Reflexes

  1. Biceps

    Biceps (musculocutaneous nerve – C5, C6)

  2. Triceps

    Triceps (radial nerve – C7, C8)

  3. Brachioradialis/supinator

    Brachioradialis/supinator (radial nerve – C5, C6)

  4. Finger jerk

    Finger jerk (median nerve – C8)

  5. Compare sides

    Test both sides and compare

  6. Report findings

    Report findings correctly

  7. Reflex-level assessment limitation

    Students should know (but need not report) which levels are tested with each reflex; may be tested in written exam.

Step 6. Coordination

  1. Finger-nose test

    Finger-nose test

  2. Rapidly alternating movements

    Rapidly alternating movements

  3. Compare sides

    Test both sides and compare

  4. Report findings

    Report findings correctly

Step 7. Light Touch Sensation

  1. Demonstrate with a reference point

    Demonstrate using reference point

  2. C3

    C3 supraclavicular fossa

  3. C4

    C4 top of AC joint

  4. C5

    C5 lateral side of antecubital fossa

  5. C6

    C6 thumb

  6. C7

    C7 middle finger

  7. C8

    C8 little finger

  8. T1

    T1 medial (ulnar) side of antecubital fossa

  9. T2

    T2 apex of axilla

  10. Compare sides

    Test bilaterally and compare; ask if sensation is the same on both sides

  11. Report findings

    Report findings correctly

  12. Additional dermatome sites — comment only

    Comment only on where to test T4 (4th ICS/nipple line) and T10 (level with umbilicus)

  13. Dermatome assessment limitation

    Students should know (but need not report) which dermatome is tested at each site; may be tested in written exam.

Step 8. Pain Sensation

  1. Demonstrate with a reference point

    Demonstrate using reference point

  2. Dermatomes

    Same dermatomes as light touch (C3–T2)

  3. Sharp/dull technique

    Correct technique using sharp/dull sides

  4. Neurotip disposal

    Correct disposal of Neurotip

  5. Compare sides

    Test bilaterally and compare; ask if sensation is the same on both sides

  6. Report findings

    Report findings correctly

  7. Additional dermatome sites — comment only

    Comment only on where to test T4 (4th ICS/nipple line) and T10 (level with umbilicus)

  8. Dermatome assessment limitation

    Students should know (but need not report) which dermatome is tested at each site; may be tested in written exam.

Step 9. Vibration Sensation

  1. Explain to the patient

    Explanation to patient

  2. Technique

    Appropriate technique

  3. Compare sides

    Compare both sides; ask if sensation is the same

  4. Report findings

    Report findings correctly

Step 10. Proprioception

  1. Explain to the patient

    Explanation to patient

  2. Technique

    Appropriate technique

  3. Compare sides

    Compare both sides

  4. Report findings

    Report findings correctly

Step 11. Conclusion

  1. Thank the patient and allow redressing

    Thank patient and indicate they may redress

  2. Communication

    Appropriate communication

  3. Hand hygiene

    Hand wash/rub

Enable JavaScript to use the interactive checklist. Sign in to save your examination progress across devices.