quick neuromotor exam for the hand

14 Oct

with any upper extremity injury, there’s a potential for nerve injury (e.g. with a posterior elbow dislocation, FOOSH, etc).


so having a quick system for rapid assessment in the ED is key

“thumb’s up” -> median nerve

“OK sign” -> median nerve 

“little finger out” (abducted, against resistance) -> ulnar nerve

extend fingers/wrist -> radial nerve


Careful with these if not in the States.  some of these signs can be offensive in certain cultures.



combining those, I usually have my patients give me a quick ‘thumbs up’, ‘OK sign’, then spread their fingers out and in full extension (against resistance).  probably done in less than 10 seconds.


also, here’s a quick reminder on sensory distribution in the hand:


References: procedural pause post on elbow disloc; medscape article; picture


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