Regarding the sensory exam

[EUstudent]

Hi all!

Just wanted to have your input on the sensory exam. I´ve met many neurological patients but only recently started to reflect on how I can improve my clinical exam. Just wanted to hear how you are doing on your sensory exam. I (of course) adjust to the current situation - if the patient doesn´t complain of any sensory deficits I just examine quickly and peripherally (hands/feet) with a needle and tuning fork. If the patient has some sort of sensory complaint on for example the radial part of the arm (or whatever) I usually use a needle on that arm to try and localize the area as precise as possible - and see if it fits with any dermatome or peripheral nerve. The other side, with no complaint - I just test peripherally (hand) with a needle.

If the patient feels that he or she has parasthesias or some deficit involving a whole side or for example both legs up to umbilical level, i examine a bit less thoroughly with both needle and tuning fork, distally to proximally - to find a sensory level (and to see what sensory domains are affected).

Sound legit? Thankful for your feedback!

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[deathmerchant]

This question is worded in a way that's hard to understand. You must also be early in your medical/neurology journey. Its hard to explain this here, because there are hundreds of concepts to think about in a sensory exam. Best option is to find a mentor- neurologist or a senior neuro resident and have them go through the examination with you. Can also read some neurology books on examination and approach to a patient with sensory signs/symptoms. If you have a more specific question, we can try to help.

 

[EUstudent]

Thanks. My question is: how would you go ahead with your sensory exam exactly if someone has a small area of loss on an extremity in order to see exactly what area is affected?

 

[DrSatan]

If someone is coming in with sensory loss you should check every limb for every modality (light touch, cool temperature, vibratory, pinprick, and proprioception). I will alter what I do depending on which modality is impaired and where the affected region is.

 

[EUstudent]

Thank you sir! But the limb affected (which the patient complain about) you examine more carefully to find the exact area?

 

[DrSatan]

Thank you sir! But the limb affected (which the patient complain about) you examine more carefully to find the exact area?

Yes. I look to see if it fits a dermatomal pattern or not and would repeat the same testing (ie, light touch, pinprick) on the contralateral limb, perhaps more extensively depending on on what I find.

 

[EUstudent]

If the patient does not complain of a sensory deficit on for example his right arm, I guess its ok to test that side not so thoroughly as the side which the patient complains about?

 

[DrSatan]

If someone complains of sensory deficit in their left arm, I'd likely always check the contralateral arm to the same extent. You can do the contralateral arm more quickly if you are not finding anything abnormal.