Makindo Medical Notes

Related Subjects: |OSCE Eye Exam |OSCE Ear Exam |OSCE Abdominal Exam |OSCE Testicular Exam |OSCE Inguinal Exam |OSCE Upper limb Neurology

👋 Introduction

• 🧼 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

🪜 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