Chapter 025. Numbness, Tingling, and Sensory Loss (Part 3)

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Examination of Sensation The main components of the sensory examination are tests of primary sensation (pain, touch, vibration, joint position, and thermal sensation; Table 251). Table 25-1 Testing Primary Sensation Sense Test Device Endings Activated er Fib Size ral Cent Mediatin g Pathway Pain ick Pinpr Cutaneous nociceptors all Sm SpTh , also D Temperat ure, heat m object War Cutaneous for all Sm SpTh metal thermoreceptors hot Temperat ure, cold Cold metal object Cutaneous thermoreceptors cold for all Sm SpTh Touch Cotto Cutaneous ge small Lar Lem, n wisp, fine mechanoreceptors, brush also naked endings and also D and SpTh Vibration Tuni ng fork, 128 tors, Hz Mechanorecep especially ge Lar also D Lem, pacinian corpuscles Joint ve Passi Joint capsule and tendon endings, Lar Lem, position movement of specific muscle spindles ge also D joints Note: D, diffuse ascending...

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Chapter 025. Numbness, Tingling, and Sensory Loss (Part 3) Examination of Sensation The main components of the sensory examination are tests of primary sensation (pain, touch, vibration, joint position, and thermal sensation; Table 25- 1). Table 25-1 Testing Primary Sensation Sense Test Endings Fib Cent Device Activated er Size ral Mediatin Pathway g
Pain Pinpr Cutaneous Sm SpTh ick nociceptors all , also D Temperat War Cutaneous Sm SpTh ure, heat m metal thermoreceptors for all object hot Temperat Cold Cutaneous Sm SpTh ure, cold metal object thermoreceptors for all cold Touch Cotto Cutaneous Lar Lem, n wisp, fine mechanoreceptors, ge and also D and brush also naked endings small SpTh Vibration Tuni Mechanorecep Lar Lem, ng fork, 128 tors, especially ge also D Hz pacinian corpuscles Joint Passi Joint capsule Lar Lem, ve and tendon endings,
position movement muscle spindles ge also D of specific joints Note: D, diffuse ascending projections in ipsilateral and contralateral anterolateral columns; SpTh, spinothalamic projection, contralateral; Lem, posterior column and lemniscal projection, ipsilateral.Some general principles pertain. The examiner must depend on patient responses, particularly when testing cutaneous sensation (pin, touch, warm, or cold), which complicates interpretation. Further, examination may be limited in some patients. In a stuporous patient, for example, sensory examination is reduced to observing the briskness of withdrawal in response to a pinch or other noxious stimulus. Comparison of response on one side of the body to the other is essential. In the alert but uncooperative patient, it may not be possible to examine cutaneous sensation, but some idea of proprioceptive function may be gained by noting the patient's best performance of movements requiring balance and precision. Frequently, patients present with sensory symptoms that do not fit an anatomic localization and that are accompanied by either no abnormalities or gross inconsistencies on examination. The examiner should then consider whether the sensory symptoms are a disguised request for help with psychological or situational problems. Discretion must be
used in pursuing this possibility. Finally, sensory examination of a patient who has no neurologic complaints can be brief and consist of pinprick, touch, and vibration testing in the hands and feet plus evaluation of stance and gait, including the Romberg maneuver. Evaluation of stance and gait also tests the integrity of motor and cerebellar systems. PRIMARY SENSATION (See Table 25-1) The sense of pain is usually tested with a clean pin, asking the patient to focus on the pricking or unpleasant quality of the stimulus and not just the pressure or touch sensation elicited. Areas of hypalgesia should be mapped by proceeding radially from the most hypalgesic site (Figs. 25-2 and 25-3).Figure 25-2