A14. Examination of the sensation
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- Compare both sides
- Show and tell the patient about the examination before you perform it with their eyes closed
- Examination of fine touch
- Pathway: dorsal column
- Procedure
- Ask patient to close their eyes
- Touch patient softly with finger or cotton pad
- Tell patient to tell you when they feel it
- Positive:
- Hypoesthesia: decreased sensation
- Anaesthesia: no sensation
- Allodynia: painful sensation for a non-painful stimulus
- Examination of vibration
- Pathway: dorsal column
- Procedure
- Hit a tuning fork and place it on the patient’s forehead, so they have a reference
- Ask patient to close their eyes
- Hit the fork again and place it on a bony prominence in the area to be examined
- Positive:
- Decreased or absence of vibration sensation
- Examination of proprioception (joint position)
- Pathway: dorsal column
- Procedure
- Ask patient to close their eyes
- Hold the patient’s hallux
- Move the distal joint up and down randomly, and ask the patient at random times to identify the change in position
- Perform the same movement for the 4th finger
- Positive:
- Decreased or absence of joint movement sensation
- Note: Joint position sense is extremely sensitive, so even small movements can be felt by the patient
- Examination of pain sensation
- Pathway: spinothalamic tract
- Procedure
- Ask patient to close their eyes
- Prick the patient’s skin with a pointed object
- Positive
- Analgesia: No pain sensation
- Hypoalgesia: Decreased pain sensation
- Hyperalgesia: Increased pain sensation