Assessment of the Upper Extremities

Assessment of the Upper Extremities Introduces self, name, purpose, agenda, hand-washing, and privacy Gives appropriate directions, explanations as needed _____ Skin/Vascular assessment General: color, lesions, temp, texture, turgor _____ Fingernails/Capillary refill Skin color is yellowish, color distribution even, no inflammation, no lesion, warm to touch, skin smooth texture, no turgor, well hydration, fingernail is pink color, no cyanosis, well grooming, no rigid, nail angle less than 160, no clubbing, capillary refill less than 2 second, _____ Inspect and palpate Joints/Muscles _____ Pulses (Radial, Brachial) _____ Nodes (Epitrochlear) _____ S: Joints/muscles: I will inspect then palpate the joint. Touch both sides at the same time. Say: no redness or inflammation noted, How do you feel? No pain or tenderness noted. No crepitus. Pulses: Pulse is 2+, no bounding, regular rate and rhythm, rate 70/min Nodes(epitrochlear): under bicep Using the pads of my finger I will palpate , non palpable,say: how do you feel? No pain or tenderness upon palpation L: Inspect shoulder, albow and wrist and finger, , inspect the joint in shoulder,albow, wrist and finger , and palpate (touch shulder, albow, wrist and finger (finger nail). Say: no redness, no swllowen, inflammation noted. How do you feel, no pain tenderness noted. No crepits Palpate epitrochlear node(around braiaidu it is nonpalpate, no pain/ tenderness upon palpation Palpate radius and radius pulse at the same time(say: pulse is 2+ no bounding, regular pulse and rhythm, rate is 70/min Motor exam ROM shoulder _____ ROM elbow Shoulder use circumduction(front and back) say: full range of motion on shoulder, movement is smooth and coordinated, no crepitus noted. Elbow: Do flexion/extension(open and close arm), say: full range motion on elbow, movement is smooth and coordinated, no crepitus noted. _____ ROM wrist/hand/fingers L: (role wrist(fist), dip like dad check future, open/close hand, like openshowdown) , let fin ger opern and close. No pain or tenderness. S: Please follow what I do, supinate/internate /rotate (flip and in and out), rotate for wrist(spin hand), open finger in and out and touch each finger to thumb and thumb to base _____ Muscle strength against resistance Elbow (muscle strength for albow,say elbow muscle strength is 5/5 _____ Fingers (muscle stenth for finger: , give patient to hold 2 finger,say finger muscle strength is 5/5 . like dad check future… _____ , (roll shoulder back and front), duction,rist hand superna and fonation, and rotae Sensation Pain Pain: I am going to check sensation(sharp, dull cotton applicator), let patient close eye, doput to upper/lower arm. _____ Light touch (use cotton ball), ask pt close eye, how do you feel I touch your skin? Let pt say yes? Patient can feel Light touch sentation at upper extermited, so it is intact. I am going to check What do you feel? Sharp or dull? (put on pateint’s _____patient can feel sharp and dull, so patient’s upper extremities sensation is intact. Vibration (use tunning fork, I need you close eye, when you feel vibration, please say now , and you feel vibration, saystop. Patient able to know start and stop, so vibration sense is intact diabetic patient cannot feel the sensation and vibration _____ Position : let pt close eye, to know finger up/down, pt can know when finger is up or down, so postion ….is intact _____ Graphesthesia(write sth to palm)/Stereognosis(put a object) _____ Ask pt close eye, write somethink(2) on the palm, tell me what numbers? Put something(corn)to palm, do you know what it that? Patient answer it is corn. Say: patient able to know the number on the hand, able to know the object in the palm, so graphesthsis /stereognosis is intact. Cerebellar Finger to nose, RAM _____ Cerebellar)balancd, use your finge to touch your nose, (finge to nose, RAM(rapi ator movement)—put hand out the thigh palm out/back Patient able to know finger to nese, RAM, so oooocerebellar is intact. RAM: put hand out/… DTRs (deep tendon reflex)—use handma Biceps (near brachial (use hammer to (V shape to check) _____ Triceps use hammer to (Vshape to check _____ Brachioradialis(near wrist) (use hammer to (flat shape to check _____ DTR is 2+ bilateral in the bicep, tricep and branchioradialis _____