Illustrated Guide: Peripheral Nerve Examination for Medical Students

Before starting the peripheral nerve examination, what should the examiner do?

What should the examiner confirm before conducting the examination?

What should the examiner ask the patient before beginning the examination?

How should the examiner test for drift (cerebellar or pyramidal)?

What does a positive drift test indicate?

How should the examiner assess tone during the examination?

The Thumb abduction is innervated by the __ nerve.

The Finger Flexion is innervated by the __ nerve.

The Ankle Clonus is examined by bending the leg at the knee and quickly __ foot.

Biceps reflex is a test for __ nerve function.

Hoffmann’s reflex is used to test for __ .

In hyperreflexia, __ may be elicited.

Ankle plantar flexion is innervated by the __ nerve.

Knee extension is innervated by the __ nerve.

The Finger Reflex test involves tapping the palmar surface of the middle 3 fingers while they are slightly flexed, and if positive, __ occur.

The Triceps reflex is a test for __ function.

Examine vibration with a 128 Hz tuning fork, distally, moving proximally only if __ .

The Adductor Reflex is a __ reflex.

Preparation for Peripheral Nerve Examination

Before starting the examination, the examiner should ensure the patient is comfortable and relaxed.
The examiner should confirm the patient's identity and the purpose of the examination.

Drift Test

The examiner should ask the patient to hold their arms straight out in front of them, with their palms facing downwards.
The examiner should then observe for any drift or movement of the patient's hands, which may indicate a cerebellar or pyramidal lesion.
A positive drift test indicates a lesion in the cerebellar or pyramidal tract.

Tone Assessment

The examiner should assess tone by feeling the resistance of the patient's muscles to passive movement.

Nerve Innervation

Thumb abduction is innervated by the Median nerve.
Finger Flexion is innervated by the Median and Ulnar nerves.

Reflex Tests

Ankle Clonus is examined by bending the leg at the knee and quickly dorsiflexing the foot.
Biceps reflex is a test for C5-C6 nerve function.
Hoffmann's reflex is used to test for Ulnar nerve function.
In hyperreflexia, clonus may be elicited.
Ankle plantar flexion is innervated by the S1-S2 nerve.
Knee extension is innervated by the L2-L4 nerve.

Reflex Tests (continued)

The Finger Reflex test involves tapping the palmar surface of the middle 3 fingers while they are slightly flexed, and if positive, a contraction of the fingers will occur.
The Triceps reflex is a test for C7-C8 nerve function.

Vibration Testing

Examine vibration with a 128 Hz tuning fork, distally, moving proximally only if there is a loss of vibration sense at a certain point.

Adductor Reflex

The Adductor Reflex is a L2-L4 reflex.

Learn how to conduct a peripheral nerve examination for the upper limb with this illustrated guide designed for 2nd-year medical students. The guide covers pre-examination steps, motor system examination, and more, providing a comprehensive resource for mastering this essential clinical skill.