Sensory examination

Sensory examinationCreated OnJune 2, 2020Last Updated OnOctober 27, 2020byadmin You are here: Main Clinical Examination Sensory examination < All Topics Table of Contents Basic neuro-anatomy: The sensory tracts: Dorsal column – Medial lemniscus system (Decussate at Medulla) Fine touch Pressure Vibration Stereognosis The anterolateral system – Ant and Lat. Spinothalamic tract. (Decussate at spinal cord level) Pain Temperature General points: Explain each test before you perform it. Patient’s eye must be closed during each examination Test all 4 limb extremities according to dermatomes Compare both sides and ask if both sides are the same Compare distal and proximal areas of the extremities When you detect an area of sensory loss, map out its boundaries. Light touch: Use a sharp end of a cotton wool, touch the skin with it Ask patient to respond whether a touch is felt Test in each dermatome, comparing both sides. Pain: Use a neurological pin. Dispose of the pin after each patient to avoid transmitting infections. Explain and demonstrate that the ability to feel a sharp pinprick is being tested. Map out the boundaries of any area of reduced, absent or increased sensation. Temperature: Use a cold tuning fork, touch against the skin and ask if it feels cold. To make sure temperature loss is in same distribution as pain loss Testing of temperature is usually done for patient with abnormal pain sensation. It is seldom performed Vibration: Use a 128 Hz tuning fork Strike it against your hand and place it over sternum, ask patient whether they feel it? Then place it on the tip of great toe Repeat on the other side If sensation is impaired, place the fork on the interphalangeal joint and progress proximally. Test the fingers in a similar fashion Joint position sense: With patient’s eyes open, demonstrate the procedure Hold the distal phalynx of the patient’s great toe at the sides, tell patient that you are going to move his/her toe up and down, demonstrate as you do. Then ask patient to close their eyes and to identify the direction of small movements in random order. (up/down) Test both great toes, if impaired, move to more proximal joint. Two-point discrimination: Ask the patient to look away from the finger. Use an opened-up paper clip to prick the pulp of the middle finger with either one or two tips of the clip. Ask the patient if one or two points are felt as you prick. Repeat the test on the thumb. Stereognosis (Integrative sensation): Can only be performed if light touch and position sense are intact With patient eyes closed, place a familiar object (coin, key, pen) in patient’s hand Ask patient to identify the object Graphesthesia (Integrative sensation): Can only be performed if light touch is intact With patient eyes closed, use your finger, draw a number/letter in patient’s palm Ask patient to identify the number/letter Point localization: Ask the patient to close his eyes. Touch each finger of his hand and ask him to...

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