Welcome to the Comprehensive Guide on Upper Limb Neurological Screening Tests (Video in English)

In the realm of clinical practice, particularly within the framework of MDT (Mechanical Diagnosis and Therapy) McKenzie Training, adhering to safety rules is paramount. Our commitment to patient safety and effective care led us to record a significant session during a B course in MDT McKenzie training, focusing on the indispensability of safety in clinical evaluations.
The Essence of Quick Neurological Screenings
The core of our discussion revolves around the integration of quick neurological tests into routine clinical assessments. These tests, fundamental to the MDT McKenzie training, are designed to be both rapid and thorough, aiming to pinpoint early signs of severe neurological conditions without hindering the flow of practice. Within a brief span of just 2 minutes and 30 seconds, we showcase a quick test battery that exemplifies how these evaluations are performed efficiently, yet without compromising thoroughness.
Identifying Early Signs of Neurological Issues
When patients report symptoms like pins and needles, a loss of power, or radicular pain—especially if these symptoms extend below the elbow or are accompanied by unusual sensations in the legs or alterations in gait—it’s a call to action for clinicians. These symptoms often hint at neurological involvement, necessitating immediate attention.
Delving Deeper into Neurological Screening
To enrich your understanding and application of these screenings, let’s explore the specific tests mentioned in the video content of the blog:
1. Dermatome Sensitivity Testing in the Upper Limb
Dermatomes are specific areas of skin innervated by sensory fibers from a single spinal nerve root. Testing dermatome sensitivity is crucial for identifying potential nerve root compression or damage. For the upper limb, the key dermatomes and their corresponding nerve roots are:
C5: Covers the outer part of the upper arm and extends down to the elbow. Sensitivity can be tested by lightly touching or applying a pinprick to this area.
C6: Encompasses the thumb and index finger, as well as the radial (thumb) side of the forearm. Testing here helps identify issues potentially affecting the C6 nerve root.
C7: Involves the middle finger and the dorsal aspect of the forearm. This is a critical area for testing, as C7 nerve root issues are common.
C8: Concerns the little finger and the medial (ulnar) side of the forearm, providing insight into the function of the C8 nerve root.
T1: Involves the inner aspect of the upper arm to the elbow. Testing T1 dermatome sensitivity can help uncover upper limb issues not immediately apparent.
2. Strength Tests of the Upper Limb
Strength testing evaluates the motor function of muscles supplied by various nerve roots. Key tests include:
Elbow Flexion and Extension: Testing the biceps (C5-C6) for flexion and the triceps (C6-C7) for extension evaluates the strength and possible compression of these nerve roots.
Thumb Extension: Evaluates the radial nerve (C8), important for diagnosing radial nerve compression.
Adduction of the pink : (T1), crucial for hand function.
3. Reflex Assessments
Reflex testing is essential for assessing the integrity of the spinal cord and nerve roots. The primary reflexes of the upper limb include:
Biceps Reflex (C5-C6): Indicates the health of the C5 and C6 nerve roots.
Triceps Reflex (C7): Reflects the condition of the C7 nerve root.
Hoffmann’s and Tromner Reflex: which can help verify the presence or absence of issues arising from the corticospinal tract.
The Inverted Supinator Sign is a common neurological test used in the physical assessment of upper motor neuron lesions.

Unusual findings in these areas, such as hyperreflexia, hyporeflexia, or the presence of pathologic reflexes like Hoffmann's sign, tremor, or Babinski's sign in the upper limb, necessitate a deeper investigation into potential neurological compromise.
Conclusion: The Value of Mastery in Neurological Screenings
These quick neurological screenings are not mere procedural steps but pivotal elements in our diagnostic toolkit. By accurately conducting dermatome sensitivity tests, strength assessments, and reflex evaluations, healthcare professionals can significantly enhance their ability to detect and intervene in neurological disorders at an early stage.
Thank you for joining this deep dive into upper limb neurological screening tests. Your dedication to refining these skills will undoubtedly contribute to superior patient care and outcomes.

References:

Cook CE et al, 2011, Jiang Z et al,2023