A14. Examination of the sensation

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