Extremity Assessment & Tests - Health Assessment for Nursing, Head To Toe |


Hi, I’m Maris! In today’s article, I’m going to walk you through the process of assessing extremities, with a special focus on some essential upper extremity assessment tests. I’ll be using our Health Assessment Flashcards as a reference throughout this guide. You can find these flashcards on our website at LevelUpRN.com. If you’re someone who prefers digital tools, I highly recommend checking out Flashables, the digital version of our flashcards, for easy on-the-go learning.


Let’s get started with the essentials!

Step-by-Step Approach to Extremity Assessment

When assessing extremities, it’s important to follow a clear, systematic process to ensure that you don’t miss anything. While our flashcards break down the assessment for upper and lower extremities separately, for the purposes of this video, I’ll combine both into one cohesive guide. That said, it’s still a good idea to review the individual cards for more specific details on things like pulse points and lymph nodes.

Let’s walk through the basic steps involved:

1. Visual Inspection

Begin by inspecting the extremities. Here are key things to look out for:

  • Symmetry: Ensure both limbs look alike. Any asymmetry might indicate underlying issues.
  • Edema (Swelling): Look for signs of swelling, which could point to fluid retention or circulatory problems.
  • Skin Color: Check for changes in color such as paleness, redness, or bluish tones. These could signal circulation issues or oxygen deprivation.
  • Deformities or Vericosities: Look for varicose veins, which appear as swollen, twisted veins. While common in the legs, they can appear elsewhere, too.

2. Palpation (Touching for Assessment)

Next, use your sense of touch to gather more information. This step is critical in assessing circulation and the general condition of the skin. Here’s what you need to do:

  • Temperature & Moisture: Just like in a skin assessment, use the back of your hand to assess the temperature and moisture of the skin. This method helps you better gauge how well the body is regulating its temperature.
  • Pulse Palpation: Carefully palpate pulses to check for good blood circulation. Depending on the level of detail required, check pulses in both the upper and lower extremities:
    • Upper Extremities: Palpate the radial, ulnar, and brachial pulses.
    • Lower Extremities: Check pulses like dorsalis pedis, posterior tibialis, popliteal, and femoral pulses.

3. Capillary Refill Test

This simple test helps assess peripheral circulation. To do this:

  • Press down on a fingernail or toenail, then release it and observe how quickly the color returns to the nail bed. Normal capillary refill should take less than 2 seconds. Any delay could indicate circulatory issues.

4. Lymph Node Assessment

Check for lymphadenopathy (swollen lymph nodes). This could suggest an infection, inflammation, or other health conditions. Feel gently along key areas where lymph nodes are found, such as the axilla (armpits) and groin.

5. Range of Motion (ROM) and Muscle Strength Testing

Assess both joint flexibility (ROM) and muscle strength. This part of the assessment helps identify any limitations due to injury, weakness, or other musculoskeletal conditions.

Key Upper Extremity Tests You Should Know

Now that you understand the basics of extremity assessment, let's dive into three common and critical upper extremity tests that assess for conditions like carpal tunnel syndrome or nerve compression.

These tests are especially important and the bold red text on our flashcards highlights the most crucial details for your learning. Let’s break them down:

1. Modified Allen Test

Why Perform This Test?
Before performing a radial artery puncture (for example, when drawing arterial blood gas samples), you need to make sure that the patient’s hand has adequate collateral circulation. This ensures that, if the radial artery is compromised, the ulnar artery can still supply blood to the hand.

Test Procedure:

  1. Occlude both the radial and ulnar arteries at the same time.
  2. Ask the patient to open and close their fist or flap their hand to help “drain” blood from the hand.
  3. The hand will appear pale. This is expected, as it means blood is no longer flowing into the hand.
  4. Release the ulnar artery and observe the hand. If the color quickly returns, it indicates good collateral circulation via the ulnar artery. If the hand remains pale, there may be a problem with ulnar flow, making it unsafe to proceed with a radial artery puncture.

Note: This is the Modified Allen Test. A full Allen test involves occluding both arteries again but releasing the radial artery first. For blood gas collection, we only use the modified version.

2. Phalen’s Test

Why Perform This Test?
Phalen’s test helps identify carpal tunnel syndrome caused by compression of the median nerve as it passes through the wrist.

Test Procedure:

  1. Ask the patient to place the backs of their hands together, forming a 90-degree angle at the wrists.
  2. Instruct them to hold the position for 30 seconds.
  3. Normal result: The patient should feel no tingling or discomfort.
  4. Abnormal result: If the patient feels tingling or discomfort, this could indicate median nerve compression, which is a hallmark of carpal tunnel syndrome.

3. Tinel’s Test

Why Perform This Test?
Tinel’s test is another assessment for carpal tunnel syndrome and helps detect median nerve irritation at the wrist.

Test Procedure:

  1. Ask the patient to extend their wrist.
  2. Gently tap over the median nerve on the inner wrist (near the carpal tunnel area).
  3. Normal result: No pain, tingling, or numbness.
  4. Abnormal result: If the patient reports tingling, pain, or a pins-and-needles sensation, this suggests median nerve compression, further indicating potential carpal tunnel syndrome.

Tip for Remembering: The name Tinel is easy to link with tapping (think "Tapping on Tinel").

Quick Quiz: Test Your Knowledge!

Let’s review what we’ve covered with a few quick questions:

  1. What test should the nurse perform before obtaining a radial artery blood gas sample?

    • Modified Allen Test

  2. What might a positive Tinel’s test indicate?

    • Median nerve compression or carpal tunnel syndrome

  3. What is the expected result of Phalen’s test?

    • No tingling or numbness

Wrap-Up: Key Takeaways

Thank you for sticking with me until the end! I hope this video helped you better understand how to assess extremities and perform essential upper extremity tests.

Your feedback matters:

  • What new information did you find most helpful?
  • Do you have any tips to remember these tests?

Leave a comment below to share your insights! Your tips could help other nursing students learn more effectively.


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