Sensory Assessment

General

• Explain each test before you do it.

• Unless otherwise specified, the patient's eyes should be closed during the actual testing.

• Compare symmetrical areas on the two sides of the body.

• Also compare distal and proximal areas of the extremities.

• When you detect an area of sensory loss map out its boundaries in detail.

Vibration

• Use a low pitched tuning fork (128Hz).

  1. Test with a non-vibrating tuning fork first to ensure that the patient is responding to the correct stimulus.

  2. Place the stem of the fork over the distal interphalangeal joint of the patient's index fingers and big toes.

  3. Ask the patient to tell you if they feel the vibration.

• If vibration sense is impaired proceed proximally:

  1. Wrists

  2. Elbows

  3. Medial malleoli

  4. Patellas

  5. Anterior superior iliac spines

  6. Spinous processes

  7. Clavicles

Subjective Light Touch

• Use your fingers to touch the skin lightly on both sides simultaneously.

• Test several areas on both the upper and lower extremities.

• Ask the patient to tell you if there is difference from side to side or other "strange" sensations.

Position Sense

1. Grasp the patient's big toe and hold it away from the other toes to avoid friction.

2. Show the patient "up" and "down."

3. With the patient's eyes closed ask the patient to identify the direction you move the toe.

4. If position sense is impaired move proximally to test the ankle joint.

5. Test the fingers in a similar fashion.

6. If indicated move proximally to the metacarpophalangeal joints, wrists, and elbows.

Dermatomal Testing

If vibration, position sense, and subjective light touch are normal in the fingers and toes you may assume the rest of this exam will be normal.

• Pain

• Use a suitable sharp object to test "sharp" or "dull" sensation. [7]

• Test the following areas:

  1. Shoulders (C4)

  2. Inner and outer aspects of the forearms (C6 and T1)

  3. Thumbs and little fingers (C6 and C8)

  4. Front of both thighs (L2)

  5. Medial and lateral aspect of both calves (L4 and L5)

  6. Little toes (S1)

• Temperature

• Often omitted if pain sensation is normal.

• Use a tuning fork heated or cooled by water and ask the patient to identify "hot" or "cold."

• Test the following areas:

  1. Shoulders (C4)

  2. Inner and outer aspects of the forearms (C6 and T1)

  3. Thumbs and little fingers (C6 and C8)

  4. Front of both thighs (L2)

  5. Medial and lateral aspect of both calves (L4 and L5)

  6. Little toes (S1)

• Light Touch

• Use a fine wisp of cotton or your fingers to touch the skin lightly.

• Ask the patient to respond whenever a touch is felt.

• Test the following areas:

  1. Shoulders (C4)

  2. Inner and outer aspects of the forearms (C6 and T1)

  3. Thumbs and little fingers (C6 and C8)

  4. Front of both thighs (L2)

  5. Medial and lateral aspect of both calves (L4 and L5)

  6. Little toes (S1)

Category: Medicine Notes