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Jørgen Riis Jepsen and Carl-Go ran Hagert

ENJ 2010; 2:(2). Month 2010

Patients with work-related upper limb conditions frequently present a triad of neuropathic symptoms like pain, weakness, and numbness/tingling that suggests involvement of the peripheral nerves. Consequently, the physical examination must be able to identify or rule out an impaired function of these. Here we propose an examination technique based on a recognized classical paradigm, namely that impaired function of a peripheral nerve leads to reduced strength of the muscles it innervates. We have previously validated an extensive physical examination of the upper limb nerves and found that it enabled us to accurately identify and locate nerve afflictions in a high proportion of patients and occupationally exposed subjects. This relatively extensive approach may be regarded as complicated and time consuming. Therefore, we review the technique and interpretation of an easy and rapid assessment of three antagonist muscle pairs (Pectoral*Posterior deltoid, Biceps*Triceps, Flexor carpi adialis*Extensor carpi radialis brevis) and three additional individual muscles (Extensor carpi ulnaris, Abductor pollicis brevis, Abductor digiti minimi). This examination enables clinicians to identify patterns of weakness in accordance with specific locations of peripheral nerve afflictions. These patterns are present in a major proportion of work-related upper limb disorders, including the so-called ‘‘non specific’’ disorders that are currently uncovered by diagnostic criteria because a conventional physical examination cannot demonstrate physical abnormalities. We propose testing of these nine muscles to be routinely integrated in the physical upper limb examination.