General inspection

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