Arm Weakness / Sensory Loss
It can be helpful to think of arm weakness in terms of the cases that might present:
Common Examination Components:
(You are likely to be expected to examine the common components in each case)
Introduction for the patient e.g. ‘What you have told me suggests I need to examine your arm. Can you take your top layers off so I can see your arm and shoulder clearly’
Inspection for muscle wasting and asymmetry. (Signs are unlikely to be present in the exam)
Tone for cog wheeling, rigidity
Main Exam Menu
Main Exam Menu
Reflexes C5,6 (Supinator, Biceps), and C7 (Triceps)
Sensation Light Touch ‘Please close your eyes and let me know when you can feel me touching your arm. Let me know if anywhere I touch you feels different.’
Touch once in the dermatomes C4,5,6,7,8 & T1,2 (avoid tickling the skin as this is detected by pain sensation). Keep the timing of touches unpredictable to help prevent guesswork by the patient.
Additional Examination Components:
(Examine an additional component If the specified indication is present)
Indication: History or examination findings suggestive of sensory loss or conditions associated with dorsal column disease
Components: Proprioception and Vibration
Indication: History or examination findings suggestive of weakness or sensory loss due to nerve root problems.
Components: Neck Movements
Indication: History of clumsiness, stroke or evidence of in-coordination
Components: Coordination (finger nose pointing & dysdiadochokinesis).
Indication: History or examination of recurrent hand injuries suggesting loss of temperature sensation
Components: Temperature Sensation (syringomyelia)
What CSA Examiners and Trainers Expect - A Typical Scenario
(Study by N.Boeckx: Data from 300 GP Trainers and 16 CSA examiners)
Case Details: A 57 year old male presents with unilateral arm weakness. The cause is a cervical radiculopathy. The history and examination is consistent with cervical radiculopathy. Choose the examinations you would expect from a safe GP in a 10 minute consultation.
Case Discussion: This is a more complex type of case because the number of examination components are greater than in other cases, and the selection, application and interpretation of them requires a good understanding of some relatively complex pathologies. You can simplify the task for yourself by learning the examination steps so they become automatic. This frees you to concentrate on interpreting the information you find during examination.
It is usually readily apparent whether candidates are confident in this type of examination.