no
no
no

Upper limb examination for PACES

1) Look 
  • ? wasting, position, fasciculation or tremor
  • hold arms out with palms up. Close eyes.
    • ? slow drop - UMN weakness or fatiguability
    • ? pronator drift - suggests contra-lateral pyramidal tract lesion (UMN)
    • ? cerebellar lesion - push down and suddenly release; oscillates before returning to position

2) Tone - ? rigidity suggesting UMN lesion or extrapyramidal stiffness

3) Power
  • "Can you make chicken wings and stop me pushing you down" = shoulder abduction
  • "And stop me moving them up" = shoulder adduction
  • "Bend your elbows and don't let me straighten them" = elbow flexion
  • "And straighten them out" = elbow extension
  • "Bend your wrist and don't let me straighten it" = wrist flexion
  • "And try and straighten it out" = wrist extension
  • "Now grip my finger" = finger flexion
  • "Straighten your fingers and don't let me push them down" = finger extension
  • "Try and spread your fingers out" = finger abduction
  • "Keep this piece of paper between your fingers" = finger adduction
  • "Move your thumb up" = thumb abduction
  • "Hold this piece of paper between your thumbs and index fingers" = thumb adduction
Summary of nerve roots, nerves and muscles involved: (click on imagine for larger version)

4)  Co-ordination - finger to nose

5) Sensation
Click here to view dermatomes
Click here to view areas innervated by nerve

6) Reflexes
  • Suppinator = brachioradialis contraction = C5 and C6; mainly C6
  • Biceps = C5 and C6; mainly C5
  • Triceps = C7


Think about:
Median nerve palsy
Ulnar nerve palsy
Radial nerve palsy


Small print gem: Froment's sign = if adductor of thumb is paralysed, it flexes at the interphalangeal joint when testing thumb adduction with the paper between thumb and index finger test.
author profile image
Abdelghafour

Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book.

no
Secret collector of interesting anonymised ECGs. Fan of the Bath Photomarathon. Lover of cream teas. [Sarah Hudson] (Your Picture)