🧼 Wash hands before starting.
Introduce yourself, confirm patient’s name & DOB.
Explain: “I’d like to examine the nerves in your arms by checking strength, sensation, reflexes and coordination.”
Gain consent, ensure privacy, good lighting, and draping.

🧰 Equipment Needed

Gloves
Reflex hammer ⚡
Cotton wool/tissue (light touch)
Disposable pin/neurotip (pinprick)
128 Hz tuning fork (vibration)
Optional: pen & paper (fine motor tasks)

🧠 Clinical Pearls:
– C5 → shoulder abduction (deltoid), tested by lifting arms sideways.
– C6 → wrist extension & sensation over lateral forearm.
– C7 → triceps & sensation over middle finger.
– C8 → finger flexion & medial forearm sensation.
– T1 → interossei (finger ab/adduction).
📌 UMN lesions = spastic tone, brisk reflexes, Babinski sign in lower limb.
📌 LMN lesions = wasting, fasciculations, reduced tone and reflexes.

📚 Background: Key Myotomes & Reflexes

Level	Motor	Sensation	Reflex
C5	Deltoid (abduction)	Lateral arm	Biceps (C5–6)
C6	Wrist extensors	Lateral forearm	Brachioradialis (C5–6)
C7	Triceps	Middle finger	Triceps (C7–8)
C8	Finger flexors	Medial forearm	None
T1	Interossei (ab/adduction)	Medial arm	None

🪜 Step 1: Inspection

Observe both arms for wasting, fasciculations, tremor, scars, or contractures.
Check for posture asymmetry or involuntary movements.

💪 Step 2: Motor Examination

Power: Test shoulder abduction, elbow flexion/extension, wrist flexion/extension, finger flexion/extension, grip strength, and interossei (finger ab/adduction). Use MRC 0–5 scale.
Tone: Assess by passively moving joints. Note spasticity (UMN), flaccidity (LMN).

🖐️ Step 3: Sensory Examination

Light Touch: Cotton wool over C5–T1 dermatomes. Compare both sides.
Pinprick: Use neurotip for sharp sensation.
Vibration: 128 Hz tuning fork on MCP joints/wrist.
Proprioception: Move thumb/finger up or down with eyes closed.

⚡ Step 4: Reflexes

Biceps: C5–6.
Brachioradialis: C5–6.
Triceps: C7–8.
Compare bilaterally; note hyperreflexia (UMN) or hyporeflexia (LMN).

🎯 Step 5: Coordination & Fine Motor

Finger-to-Nose: Dysmetria suggests cerebellar disease.
Rapid Alternating Movements: Look for dysdiadochokinesia.
Fine Motor Tasks: Finger tapping, writing, or drawing a spiral.

🩺 Step 6: Special Tests (if indicated)

Tinel’s Sign: Tapping median nerve at wrist → paraesthesia (carpal tunnel).
Phalen’s Test: Flex wrist 60s → tingling in median distribution.

✅ Step 7: Closure

Thank patient, redress, ensure comfort.
Summarise findings: “Normal tone and reflexes but reduced C7 sensation suggests possible radiculopathy.”
Wash hands and document thoroughly.

⭐ Key OSCE Tips

Systematic: Inspection → Motor → Sensory → Reflexes → Coordination → Specials.
Explain steps clearly to gain cooperation.
Always compare sides.
Correlate deficits with specific nerve roots or peripheral nerves.

🚫 Common Pitfalls

Not explaining procedure → poor cooperation.
Testing only one dermatome/myotome → miss subtle deficit.
Forgetting to test proprioception/vibration.
Rushing reflexes → false negatives.

📚 References

Clinical Examination – Talley & O’Connor
Geeky Medics OSCE Guide
OSCEstop – Practice stations

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OSCE Upper Limb Neurology Examination

👋 Introduction