SENSORY EXAMINATION is a topic covered in the Harrison's Manual of Medicine.

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  • The bare minimum: Ask whether the pt can feel light touch and the temperature of a cool object in each distal extremity. Check double simultaneous stimulation using light touch on the hands.

For most purposes it is sufficient to test sensation to pinprick, touch, position, and vibration in each of the four extremities (Figs. 180-1 and 180-2). The Romberg maneuver, primarily a test of proprioception, is tested as follows: pt is asked to stand with feet together while eyes are open, and eyes are then closed; loss of balance with the eyes closed is an abnormal response. Specific problems often require more thorough evaluation. Pts with cerebral lesions may have abnormalities in “discriminative sensation” such as the ability to perceive double simultaneous stimuli, to localize stimuli accurately, to identify closely approximated stimuli as separate (two-point discrimination), to identify objects by touch alone (stereognosis), or to judge weights, evaluate texture, or identify letters or numbers written on the skin surface (graphesthesia).

FIGURE 180-1

The cutaneous fields of peripheral nerves. (Reproduced by permission from W Haymaker, B Woodhall: Peripheral Nerve Injuries, 2nd ed. Philadelphia, Saunders, 1953.)

FIGURE 180-2

Distribution of the sensory spinal roots on the surface of the body (dermatomes). (From D Sinclair: Mechanisms of Cutaneous Sensation. Oxford, UK, Oxford University Press, 1981; with permission from Dr. David Sinclair.)

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