If a pyramidal weakness is suspect (i.e. a weakness arising from damage to the motor cortex or descending motor tracts (see pages 189-193) the following test is simple, quick, yet sensitive.

Ask the patient to hold arms outstretched with the hands supinated for up to one minute. The eyes are closed (otherwise visual compensation occurs). The weak arm gradually pronates and drifts downwards.

With possible involvement at the spinal root or nerve level (lower motor neuron), it is essential to test individual muscle groups to help localise the lesion.

When testing muscle groups, think of root supply and nerve supply.

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