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% Document Info
\author{hjsdhaj}
\pdfinfo{
  /Title (neurological-examination-of-the-upper-limbs.pdf)
  /Creator (Cheatography)
  /Author (hjsdhaj)
  /Subject (Neurological Examination of the Upper Limbs Cheat Sheet)
}

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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Neurological Examination of the Upper Limbs Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{hjsdhaj} via \textcolor{DarkBackground}{\uline{cheatography.com/201639/cs/42993/}}}
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\begin{multicols}{3}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}hjsdhaj \\
  \uline{cheatography.com/hjsdhaj} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 11th April, 2024.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
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\begin{document}
\raggedright
\raggedcolumns

% Set font size to small. Switch to any value
% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.

\begin{multicols*}{2}

\begin{tabularx}{8.4cm}{p{0.88 cm} x{7.12 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Introduction:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{W}} & Wash Hands \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{I}} & Introduce Yourself + Patient's Identity \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{P}} & Permission \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{P}} & Patient Position + Pain \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
{\bf{E}} & Explaination \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Patient must be placed at 45° and {\emph{limbs exposed}}}} \{\{ac\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{p{0.8 cm} x{7.2 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Equipment:}}  \tn
% Row 0
\SetRowColor{LightBackground}
 & Cotton Wool\{\{nl\}\}Neurotips\{\{nl\}\}Tendon Hammer\{\{nl\}\}128Hz Tuning Fork \tn 
% Row Count 2 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{4.24 cm} x{3.76 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{General Inspection:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{•Postural abnormalities and deformities} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{•Leaning or facial asymmetry} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{•Muscle wasting, fasciculations, or tremor} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{8.4cm}}{•Abnormal movements} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{•Obvious discomfort or pain} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
•Medical paraphernalia: & Walking aids, Calipers \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{8.4cm}}{{\bf{Ask patient to lean forward and examine {\emph{back/scapulae}}}} \{\{ac\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{1.216 cm} x{3.192 cm} x{3.192 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Tone:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{8.4cm}}{{\bf{{\emph{Check for pain before starting}}}}\{\{ac\}\}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
{\bf{Check tone:}} & Ask patient to rotate arm at shoulder\{\{nl\}\}\{\{nl\}\}Flex and extend arms at elbow\{\{nl\}\}\{\{nl\}\}Supination and pronation\{\{nl\}\}\{\{nl\}\}Flex and extend hand at wrist & Extra movement =\textgreater{} Decreased tone\{\{nl\}\}\{\{nl\}\}Less movement =\textgreater{} Rigidity \tn 
% Row Count 11 (+ 10)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{8.4cm}}{{\bf{Increased Tone:}} \newline  • Clasp knife rigidity \newline  • Clonus \newline  • Cog wheeling \newline  • Lead pipe rigidity \newline {\bf{Decreased Tone:}} \newline  • lower motor neuron lesion}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}---}
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\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{1.444 cm} x{3.116 cm} x{3.04 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Power:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{8.4cm}}{{\bf{Test both left and right limbs, directly comparing each movement in turn.\{\{nl\}\}\{\{nl\}\}The patient should perform each movement on their own and then attempt with the examiner resisting the movement}}\{\{ac\}\}} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
{\bf{Pronator Drift:}} & Ask patient to stretch both arms out in front of them with their eyes closed and palms facing upwards. & Indication of muscle weakness, abnormal function of the corticospinal tract and upper motor neurons \tn 
% Row Count 12 (+ 7)
% Row 2
\SetRowColor{LightBackground}
{\bf{Shoulders:}} & Abduction + Adduction & Ask patient to "Chicken Wing" and push up/down against your hands \tn 
% Row Count 17 (+ 5)
% Row 3
\SetRowColor{white}
{\bf{Elbows:}} & Flexion + Extension & Ask patient to flex/extend arm towards/away from you \tn 
% Row Count 21 (+ 4)
% Row 4
\SetRowColor{LightBackground}
{\bf{Wrist:}} & Flexion + Extension & Hands out {\bf{{\emph{with closed fist}}}}, resist pushing up/down \tn 
% Row Count 25 (+ 4)
% Row 5
\SetRowColor{white}
{\bf{Fingers:}} & Flexion + Extension\{\{nl\}\}\{\{nl\}\}Adduction + Abduction & Hands out {\bf{{\emph{with fingers straight}}}}, resist pushing up/down\{\{nl\}\}\{\{nl\}\}Hands out, spread fingers apart, resist pushing fingers together\{\{nl\}\}\{\{nl\}\}Close fingers, resist pulling apart individually \tn 
% Row Count 38 (+ 13)
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\par\addvspace{1.3em}

\vfill
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\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Power: (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
{\bf{Thumb:}} & Adduction & Patient holds out hand, resists pushing towards other fingers.\{\{nl\}\}\{\{nl\}\}Patient forms ring with thumb and pointer finger and resists opening ring \tn 
% Row Count 10 (+ 10)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{4 cm} x{4 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{Coordination:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Finger to Nose Test:}} & Past pointing, {\bf{Kinetic Tremor}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{Rapidly alternating wrist movements:}} & Supination + Pronation - {\bf{Dysdiadochokinesia}} \tn 
% Row Count 5 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{2.356 cm} x{4.484 cm} p{0.76 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Tendon Reflexes:}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{8.4cm}}{{\bf{Limb must be totally relaxed}}\{\{ac\}\}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
{\bf{Biceps:}} & Support patient's arm on yours & C5,6 \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
{\bf{Triceps:}} & Allow patients arm to hang with elbow at 90° & C7 \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{Brachioradialis:}} & Strike 2-3cm above the radial styloid process & C5,6 \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{8.4cm}}{Muscle may just contract, {\bf{may not be an obvious movement}} \newline  \newline Reflex may be {\bf{present/absent}}, or {\bf{reduced/brisk}}\{\{ac\}\}}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{x{3.192 cm} x{3.648 cm} p{0.76 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Sensation:}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Light Touch:}} & {\emph{Important to touch rather then stroke}}\{\{nl\}\}\{\{nl\}\}Lightly {\bf{touch sternum}} first using cotton wool.\{\{nl\}\}{\bf{Ask patient to close eyes }} and tell you when they feel the touch.\{\{nl\}\} {\bf{Ask if touch feels the same on both sides}} &  \tn 
% Row Count 12 (+ 12)
% Row 1
\SetRowColor{white}
 & Posterior aspect of the shoulders & C4 \tn 
% Row Count 14 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & Lateral aspect of the upper arms & C5 \tn 
% Row Count 16 (+ 2)
% Row 3
\SetRowColor{white}
 & Tip of the thumb & C6 \tn 
% Row Count 17 (+ 1)
% Row 4
\SetRowColor{LightBackground}
 & Tip of the middle finger & C7 \tn 
% Row Count 19 (+ 2)
% Row 5
\SetRowColor{white}
 & Tip of the little finger & C8 \tn 
% Row Count 21 (+ 2)
% Row 6
\SetRowColor{LightBackground}
 & Medial aspect of the lower arms & T1 \tn 
% Row Count 23 (+ 2)
% Row 7
\SetRowColor{white}
 & Medial aspect of the upper arms & T2 \tn 
% Row Count 25 (+ 2)
% Row 8
\SetRowColor{LightBackground}
{\bf{Pain:}} & Repeat same process as for light touch.\{\{nl\}\}\{\{nl\}\}Tested using a {\bf{new}} neurotip.\{\{nl\}\}{\bf{Must be disposed of in the {\emph{sharps bin}}}}. &  \tn 
% Row Count 32 (+ 7)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{8.4cm}{x{3.192 cm} x{3.648 cm} p{0.76 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{8.4cm}}{\bf\textcolor{white}{Sensation: (cont)}}  \tn
% Row 9
\SetRowColor{LightBackground}
{\bf{Temperature:}}\{\{nobreak\}\} & Tested the same way as pain/light touch, rarely done. \{\{nl\}\}\{\{nl\}\}Tested using a {\emph{cold tuning fork}}. &  \tn 
% Row Count 6 (+ 6)
% Row 10
\SetRowColor{white}
{\bf{Vibration Sense:}} (128Hz) & Strike tuning fork and hold to patient's sternum.\{\{nl\}\}Ask patient to close eyes. &  \tn 
% Row Count 11 (+ 5)
% Row 11
\SetRowColor{LightBackground}
 & Begin on most distal bony prominance {\bf{(Tip of middle finger, working proximally on each bony prominance)}} &  \tn 
% Row Count 17 (+ 6)
% Row 12
\SetRowColor{white}
{\bf{Proprioception:}}\{\{nobreak\}\} & Hold middle finger at middle phalanx, ask patient to close eyes. \{\{nl\}\}\{\{nl\}\}Demonstrate up/down for the patient, then repeat in a random direction, asking the patient to say which direction the toe is moving.\{\{nl\}\}\{\{nl\}\}Repeat 3 times for both sides.\{\{nl\}\}\{\{nl\}\}Continue up finger/arm until patient is correct &  \tn 
% Row Count 34 (+ 17)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{MRC Muscle Power Scale:}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/hjsdhaj_1712762158_MRCMPS.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Upper Limbs Dermatome Map:}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/hjsdhaj_1712762176_Upper-limb-dermatome-map.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}