You never have to perform a neurological exam on a patient with an extremity complaint.

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Evaluating an extremity complaint includes checking for neurological involvement whenever there are signs that nerves may be affected. If a patient experiences numbness, weakness, tingling, loss of sensation, or abnormal reflexes, it’s essential to perform a neurological exam to identify deficits, localize the problem, and guide management. The presence of neurological signs or symptoms is a clear cue to assess motor function, sensation, reflexes, and coordination in the affected limb.

Saying you never have to perform a neurological exam is incorrect because neurological deficits can accompany many extremity issues, not just spinal problems. It’s not limited to spinal causes; peripheral nerve injuries and other conditions can produce the same kinds of neuro signs. A vague “not necessarily” is less precise than the rule that signs or symptoms prompt a targeted neurological assessment.