motor assesment- upper limb

Begin the examination of the motor system by observing the patient's body position at rest and during movement. I'm going to move these up for a minute. Also watch for involuntary movements. Can I see your hands? Next, assess muscle characteristics beginning with muscle bulk. To do this, carefully inspect the muscles of the shoulders, arms, hands, thighs and legs, noting any atrophy. Let me do all the work here. Then evaluate the patient's muscle tone or resistance to passive stretch. Encourage the patient to relax. Then take one hand in yours and while supporting the elbow, flex and extend the patient's fingers, wrist, elbow and shoulder in one coordinated movement.

The patient's arm should move easily and smoothly with little resistance. Repeat on the other side. Once again, let me do all the work. To assess muscle tone in the legs, extend the patient's leg at the knee and move the foot up and down at the ankle. Note the patient's resistance to your movements. Assess muscle strength using force compatible with the patient's strength. Usually, the patient's dominant side is stronger than the non-dominant side. Begin by testing flexion and extension at the elbow by having the patient pull and push against your hand.

Straighten it out, bend your fist back. Next, test extension of the wrist. Make a fist, bend your fist back. Now test the patient's grip. Cross your middle and index fingers to protect them. Then ask the patient to squeeze as hard as possible while you try to remove your fingers. Normally, you should have trouble removing them. Continue testing muscle strength by asking the patient to turn his palm down and spread his fingers. Check abduction by trying to force them together. Relax for a second. Then test opposition of the thumb.

To do this, ask the patient to try to touch the tip of his little finger with the thumb while you resist the movement.