Motor Exam - Upper Extremity

 

 

Tone

Upper limbs: biceps extension, forearm, supination, wrist rotation (useful for picking up rigidity, as in Parkinson's)

 

 

 

 

Nerve Roots

  • C5
  • C6
  • C7
  • C8
  • T1

C5

 

Motor:

  • biceps flexion - C5, 6: musculocutaneous nerve
  • deltoid - C5, 6: axillary nerve

Reflex:

  • biceps

Sensation:

  • lateral arm, above deltoid - axillary nerve

C6

Motor:

  • biceps flexion - C5-C6 musculocutaneous nerve
  • wrist extensors - C6-C7 radial nerve

 

Reflex:

  • brachioradialis
  • biceps

 

Sensation:

lateral forearm, thumb, index, half of middle finger - remember by making a "6" with these fingers

C7

Motor:

  • triceps: C6,7,8 - radial nerve
  • finger extension: C7 - radial nerve
  • wrist flexors: C7 - median and ulnar nerves
  • pronator teres: C6, 7 - median nerve

Reflex:

  • triceps reflex

Sensation:

  • middle finger

C8

Motor:

  • finger flexion -
  • finger abduction - C8, T1
  • finger adduction C8, T1

 

Reflex:

none

Sensation:

  • medial forearm, ring and little finger

T1

Motor:

  • finger abduction - C8, T1
  • finger adduction C8, T1

 

Reflex:

none

 

 

Sensation:

medial upper forearm and arm

 

 

Nerves

  • musculocutaneous nerve
  • axillary nerve
  • radial nerve
  • median nerve
  • ulnar nerve

musculocutaneous nerve

 

origins and path

  • from C5,6,7
  • travels within biceps and brachioradialis
  • becomes lateral cutaneous nerve of forearm at elbow

musculature

  • biceps brachii
  • coracobrachialis
  • brachialis

sensory

  • lateral cutaneous nerve of forearm innervates just that

axillary nerve

 

origins

musculature

sensory

  • superior lateral cutaneous nerve of arm - deltoid area

radial nerve

 

origins

musculature

  • wrist extensors

sensory

  • lateral dorsal hand

median nerve

 

origins and path:

  • from C5,6,7,8T1
  • travels down centre of anterior arm

musculature

  • pronator teres - pronation
  • wrist flexors
  • flexor pollicis brevis (thenar)

sensory

  • lateral palm
  • palmar surface of thumb and first 2.5 fingers

ulnar nerve

 

origins and pathway

  • from C7,8,T1
  • travels behind medial epicondyle

musculature

  • flexor digitorum profundus
  • flexor pollicis brevis
  • palmar and dorsal interosseus muscles (abducsion/adduction)

sensory

  • medial hand, with pinkie and 1/2 of ring finger