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General inspection

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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When inspecting the upper limb in the neurological examination, one should:

  • shake the patient's hand when you introduce yourself - if the patient cannot relax his hand grip then this is myotonia - commonest cause of this is myotonic dystrophy
  • pause briefly for general inspection
  • ask the patient to undress and expose the arms and shoulder girdles
  • if possible ask the patient to sit over the edge of the bed. Ask the patient to hold out both hands with the arms extended and look for drifting
  • ask the patient to rest the arms on the lap - inspect large muscle groups for fasciculation - if none is evident then try and elicit it by tapping the body of biceps or brachioradialis with a finger or a tendon hammer and observe once more

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