ABSTRACT
Z Assess the muscles of the hands, arms, and shoulder girdle for size, shape, and symmetry. You can also measure the circumference of the arms.
Z Ensure that the patient is not in any pain.
Z Test the tone in the upper limbs by holding the patient’s hand and simultaneously pronating and supinating and flexing and extending the forearm. If you suspect increased tone, ask the patient to clench his teeth and re-test. Is the increased tone best described as spasticity (clasp-knife) or as rigidity (lead pipe)? Spasticity suggests a pyramidal lesion, rigidity suggests an extra-pyramidal lesion.
