Upper limb examination assesses the neurological function of the upper limbs. ROM is an abbreviation for Range of Motion. UL is an abbreviation for Upper limb.

Remember with the mnemonic “The Powerful Romans Conquered Spain”:

• Ensure arms have adequate exposure
• General inspection, looking for fasciculation, muscle wasting, tremor
• Palpate, for muscle wasting and tenderness
• Test tone, asking patient if they feel any pain. Ask to relax arm
  • Grab their hand in handshake, roll it back and forth in a spin
  • Shake hand up and down
  • Shake hand sideway
  • Hold on to their elbow, and roll their hand around
• Test power, asking patient to:
  • Put elbows up, preventing pushing down and then up
  • Put arms up like fighter, preventing pushing towards and away
  • Cock wrist back, preventing pushing towards and away
  • Hold fingers up, preventing folding and pulling finger
  • Thumb, preventing folding and pulling thumb
  • Pincer grip, preventing breaking
  • Grip my finger
• Test reflexes, including:
  • Supinator reflex (aka supinator jerk, SJ), tapping 2 inches above thumb
  • Biceps reflex (aka biceps jerk, BJ), tapping just above inside part of elbow
  • Triceps reflex, tapping just above elbow on outside
• Test coordination, including:
  • Put arms in front of them, close eyes, and test for pronator drift
  • Finger to nose test, touching nose, and back
  • Dysdiadokokinesia, flipping the hand over alternatively
  • Test proprioception, asking patient to identify if they feel their finger is being moved
• Test sensation, asking patient to close eyes, and indicate when they feel touch
  • Crude and pin prick (C4, C5, C6, C7, T1)
  • Vibration sense, using a 128Hz fork
• Say that you could, do temperature (EXPLAIN: test lateral spinothalamic tract), lower limb exam, cranial nerve exam, and MMSE

• Lower limb
• Neurological exam
• Rupture of membranes (another abbreviation of ROM)