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I What are three important principles one should remember about the examination of the sensory systems?
1. The sensory examination is difficult to do and is time consuming.
2. The sensory exam is, of necessity, subjective and therefore relatively unreliable.
3. One must constantly compare equivalent points on the two sides of the body.
I In general, what parts of the body should be tested most carefully for sensory abnormalities? Why?
The face, the hands and the feet should be tested most carefully.The face is tested because of the importance of the fifth cranial nerve, while the fingers and toes are more often affected by sensory abnormalities than are more proximal parts of the body.The preferential loss of sensation in the distal extremities applies to both peripheral neuropathies and root disorders. In the latter case it is rare for a whole dermatome to show evidence of sensory loss; usually only the distal portion is affected.
Even more important than the above stated generalities is the patient's history. If the patient complains of an apparent sensory loss over the lateral thigh, concentrate your examination in that area Before you even start the examination, ask the patient to trace out the abnormal area.
Pay particular attention to areas where the patient complains of pain. Check whether these coincide with a sensory loss that is consistent with a root or peripheral nerve distribution.
What are some of the common terms patients use to describe sensory abnormalities?
Common terms used by patients to describe sensory abnormalities are:
"tingling"
"prickling"
"burning"
"numbness"
"crawling"
"pins and needles"
"electric shocks"
"feels dead"
"poor circulation"
I Two symptoms that may reflect nerve or root dysfunction are pain and paresthesias. Which is the more important?
Paresthesias are more important than pain in suggesting root or nerve irritation.This is because widespread radiation of pain (referred pain) is common in a variety of conditions which are not secondary to neurological abnormalities.Thus radiation of pain from the low back to the lower leg does not necessarily mean sciatica, nor does radiation of neck pain to the forearm and hand necessarily mean cervical root compression. Even when pain is secondary to nerve or root injury, its location may not be very helpful in localizing the lesion. In carpal...