EM in 5: Rapid Neuro Hand Exam

Author: Anna Pickens, MD (@AnnaEMin5, Creator of EMin5) // Edited by: Alex Koyfman, MD (@EMHighAK), Brit Long, MD (@long_brit), and Manpreet Singh, MD (@MprizzleER)

Welcome to this week’s edition of EMin5 by Dr. Anna Pickens.  Today we’ll review a few tips on how to do a rapid neurology exam of the hand, and the great thing is you can complete the whole thing with one swift motion!

If you have a patient with arm, neck, or head injury, it is important to do a full neurology exam, including the hand.  Specifically you should test the median, ulnar and radial nerves. 

Remember that this is two fold, the sensory exam and the motor exam. 

Here are the sensory distributions you should check for each nerve:

Next we need to test the motor nerves. 

For the median nerve, have the patient make the “ok” sign and try to pull their fingers apart.  If the nerve is intact, they should have good strength and resist you:

Next have the patient spread their fingers apart and have them resist you as you “squish” them together:

Lastly to test the radial nerve, have them make a fist and push down on their fist while they resist and pull upward.  Remember, radial nerve damage will cause wrist drop, so you are testing their ability to raise the wrist up:

And here’s one great tip – You can actually do motor testing on all three nerves if you have the patient do the following motion:

Just make sure they are abducting their 3-5th fingers and extending the wrist while doing the “ok” sign.

One more review of all 3 motions:

Suggested/Further Reading:

https://www.acep.org/education/cme/continuing-education/ecme/speakertext/lecture—master-clinician-series-the-symptom-specific-rapid-neuro-examination/

https://litfl.com/the-magic-of-the-neuro-exam/