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Dr. Shalu Jain
MD Scholor
Pt. Khushilal Sharma Govt. Auto. Ayurveda College And Institute, Bhopal (M.P.)
Five senses
Sensory Pathway
Examination of sensory system
Sensory Dermatomes
 Dermatomes :- it is an area of skin that is mainly supplied
by single spinal nerve.
Purpose :- testing of dermatomes is part of the
 Purpose :- testing of dermatomes is part of the
neurological examination looking for rediculopathy as
sensation changes within a specific dermatomes may help
in determining the pahological disc level.
Examination of sensory system
 C1 - no cutaneous supply; supplies meninges
 C2 - occiput, earlobe, angle of jaw
 C3 - nape of neck
 C4 - above clavicle
 C4 - above clavicle
 C5 - deltoid; over aspect of shoulder tip
 C6 - radial half of forearm including thinar eminence and
thumb
 C7 - longest spinous process – longest finger (middle finger)
 C8 - little finger, hypothinar eminence and ulnar aspect of
hand
 T1 - ulnar aspect of forearm
 T2 - ulnar aspect of arm
 T3 - lies in axilla
 T4 - nipple
 T4 - nipple
 T8,T10,T12 – supply rib margin, umblicus and pubis
respectively
 L1 - inguinal ligament
 L3 - lies at knee
 L4 - medial aspect of leg
 L5 - lateral aspect of leg
 S1 - includes little toe, tendo-achilles, strip of skin above
it and sole
 S2 - calf musle and hamstring
 S3, S4, S5 –perianal region
 S3, S4, S5 –perianal region
Modalities of sensation to be
tested
 Exteroceptive sensations
 Proproceptive Sensations
 Cortical sensations
Exteroceptive Senstion /Superficial sensation
Receptors in skin & mucus membrane.
 Tactile or touch
 Pain Sensation
 Temperature sensation
Touch
 fine touch – tested by cotton wool
 Crude touch – by blunt object
Temperature
 Two test tubes one
containing hot water and
the other crushed ice is
taken and placed on all the
taken and placed on all the
parts of the
Pain
 Superficial pain:- tested with a
pin prick
 Deep pain :- tested by pressing the
calves, tendo achillis or testes
Proprioceptive sensation
 Position sense
 Joint sense/ sense of passive movement
Vibratory sense
Vibration
Assessment of vibration sense is the best clinical test of
the dorsal column pathway.
A low-frequency (128 Hz) tuning fork is applied to bony
prominences.
prominences.
The patient (with closed eyes) is asked to report when the
vibration starts and stop.
s
Joint sense
 Fixing the joint, the finger/
toe is moved at terminal
interphalangeal joint ,
interphalangeal joint ,
either up or down by
holding the sides of digits.
 Patient to tell the direction
i.e. either up or down.
Position sense
• A part of limb / arm is
placed in definite position
and then he is asked to
and then he is asked to
dente the position or place
the other limb in similar
position.
Cortical sensory functions
 Point localisation (tactile location)
 Two point Discrimination
 Tactile extinction
 Sterognosis
 Graphesthesia
Sense of localzation test
 Touch a part of patient
body with his eyes closed
 Ask him to open the eyes
 Ask him to open the eyes
and place his finger of that
part
Two point discrimination test
 Ability to distinguish the contact of two separate points applied
simultaneously to the skin.
 Finger pulp & lips – 3-5 mm
 Palm – 2-3 cm
 Palm – 2-3 cm
 Sole – 4 cm
 Dorsum of foot -5 cm above
 Legs – 5cm and above
 Back – 5cm above
 If two point discrimination is lost in the presence of intact
posterior column sensations, it indicates a parital lobe lesion.
Cont…
Tactile extinction
 When two stimuli are applied
simultaneously to two
symmetrical portion of the
body, the patient neglect the
one on the opposite side of the
lesion,.
 Though individually he
appriciates the stimulus on both
side.
Graphesthesia
 The ability to recognize a
number or letter written in
the palm with closed eyes.
 This ability is lost in
sensory cortex lesion
Stereognosis test
 The abilty to identify a
suitable object after
careful palpation.
careful palpation.
 This ability is lost in
sensory cortex lesion.
Sensory Changes
In
Various Diseases
Various Diseases
Poly neuropathy
 Symmetrical glove and
stocking anesthesia
(affecting distal parts
(affecting distal parts
more) involving all the
modalities of sensations.
 There is calf tenderness
Cauda equina and Conus lesions
 Loss of all modalities of
sensations involving
especially lower sacral
especially lower sacral
segments leading to
perianal anesthesia
Multiple roots involvement
 There are varying degrees of impairement of cutaneous
sensations in the distribution of the nerve roots
Pain sensation is more affected than touch.
 Pain sensation is more affected than touch.
Complete section of spinal cord
 All sensations are aboished
below a perticular level, with a
narrow zone of hyperesthesia at
the upper margin of the
anesthetic zone
 In some patients with high cord
compression sacral fibres may
be spared resulting in sacral
sparing.
Hemi section of spinal cord
 Pain and temperature is
lost a few segmentbelow a
perticular level on the
perticular level on the
opposite side whilst
vibration, position, and
joint senses are affectedon
the same side.
Syringomyelia
 Loss of pain temperature
sensation.
 Touch, vibration, joint and
 Touch, vibration, joint and
position senses are normal.
 This is also called
dissociate anesthesia.
Anterior spinal syndrome
 Loss of pain, temperature
and touch below a level
on both sides with
on both sides with
preserved position, joint
and vibration sense.
 Eg. Anterior spinal artery
thrombosis
Posterior spinal syndrome
 Loss of poosition, joint
and vibration sense below
a level with normal touch,
a level with normal touch,
temperature and pain
senses.
 Eg. Tabes dorsalis
Brain Stem Syndrome
 Loss of touch pain
temerature on same side
of the faceand opposite
of the faceand opposite
side of the body due to
involvement of trigeminal
tract or nucleus or
spinothalamic tract.
Thalamic syndrome
 Loss of all modalities of
sensations on the opposite
side of body
 Position sense are more
 Position sense are more
affected than the other
sensation.
 There may be spontaneous
pain & discomfort of the
most torturing and disabling
type.
Examination of sensory system

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Examination of sensory system

  • 1. Dr. Shalu Jain MD Scholor Pt. Khushilal Sharma Govt. Auto. Ayurveda College And Institute, Bhopal (M.P.)
  • 5. Sensory Dermatomes  Dermatomes :- it is an area of skin that is mainly supplied by single spinal nerve. Purpose :- testing of dermatomes is part of the  Purpose :- testing of dermatomes is part of the neurological examination looking for rediculopathy as sensation changes within a specific dermatomes may help in determining the pahological disc level.
  • 7.  C1 - no cutaneous supply; supplies meninges  C2 - occiput, earlobe, angle of jaw  C3 - nape of neck  C4 - above clavicle  C4 - above clavicle  C5 - deltoid; over aspect of shoulder tip  C6 - radial half of forearm including thinar eminence and thumb  C7 - longest spinous process – longest finger (middle finger)  C8 - little finger, hypothinar eminence and ulnar aspect of hand
  • 8.  T1 - ulnar aspect of forearm  T2 - ulnar aspect of arm  T3 - lies in axilla  T4 - nipple  T4 - nipple  T8,T10,T12 – supply rib margin, umblicus and pubis respectively  L1 - inguinal ligament  L3 - lies at knee  L4 - medial aspect of leg  L5 - lateral aspect of leg
  • 9.  S1 - includes little toe, tendo-achilles, strip of skin above it and sole  S2 - calf musle and hamstring  S3, S4, S5 –perianal region  S3, S4, S5 –perianal region
  • 10. Modalities of sensation to be tested  Exteroceptive sensations  Proproceptive Sensations  Cortical sensations
  • 11. Exteroceptive Senstion /Superficial sensation Receptors in skin & mucus membrane.  Tactile or touch  Pain Sensation  Temperature sensation
  • 12. Touch  fine touch – tested by cotton wool  Crude touch – by blunt object
  • 13. Temperature  Two test tubes one containing hot water and the other crushed ice is taken and placed on all the taken and placed on all the parts of the
  • 14. Pain  Superficial pain:- tested with a pin prick  Deep pain :- tested by pressing the calves, tendo achillis or testes
  • 15. Proprioceptive sensation  Position sense  Joint sense/ sense of passive movement Vibratory sense
  • 16. Vibration Assessment of vibration sense is the best clinical test of the dorsal column pathway. A low-frequency (128 Hz) tuning fork is applied to bony prominences. prominences. The patient (with closed eyes) is asked to report when the vibration starts and stop.
  • 17. s
  • 18. Joint sense  Fixing the joint, the finger/ toe is moved at terminal interphalangeal joint , interphalangeal joint , either up or down by holding the sides of digits.  Patient to tell the direction i.e. either up or down.
  • 19. Position sense • A part of limb / arm is placed in definite position and then he is asked to and then he is asked to dente the position or place the other limb in similar position.
  • 20. Cortical sensory functions  Point localisation (tactile location)  Two point Discrimination  Tactile extinction  Sterognosis  Graphesthesia
  • 21. Sense of localzation test  Touch a part of patient body with his eyes closed  Ask him to open the eyes  Ask him to open the eyes and place his finger of that part
  • 22. Two point discrimination test  Ability to distinguish the contact of two separate points applied simultaneously to the skin.  Finger pulp & lips – 3-5 mm  Palm – 2-3 cm  Palm – 2-3 cm  Sole – 4 cm  Dorsum of foot -5 cm above  Legs – 5cm and above  Back – 5cm above  If two point discrimination is lost in the presence of intact posterior column sensations, it indicates a parital lobe lesion.
  • 24. Tactile extinction  When two stimuli are applied simultaneously to two symmetrical portion of the body, the patient neglect the one on the opposite side of the lesion,.  Though individually he appriciates the stimulus on both side.
  • 25. Graphesthesia  The ability to recognize a number or letter written in the palm with closed eyes.  This ability is lost in sensory cortex lesion
  • 26. Stereognosis test  The abilty to identify a suitable object after careful palpation. careful palpation.  This ability is lost in sensory cortex lesion.
  • 28. Poly neuropathy  Symmetrical glove and stocking anesthesia (affecting distal parts (affecting distal parts more) involving all the modalities of sensations.  There is calf tenderness
  • 29. Cauda equina and Conus lesions  Loss of all modalities of sensations involving especially lower sacral especially lower sacral segments leading to perianal anesthesia
  • 30. Multiple roots involvement  There are varying degrees of impairement of cutaneous sensations in the distribution of the nerve roots Pain sensation is more affected than touch.  Pain sensation is more affected than touch.
  • 31. Complete section of spinal cord  All sensations are aboished below a perticular level, with a narrow zone of hyperesthesia at the upper margin of the anesthetic zone  In some patients with high cord compression sacral fibres may be spared resulting in sacral sparing.
  • 32. Hemi section of spinal cord  Pain and temperature is lost a few segmentbelow a perticular level on the perticular level on the opposite side whilst vibration, position, and joint senses are affectedon the same side.
  • 33. Syringomyelia  Loss of pain temperature sensation.  Touch, vibration, joint and  Touch, vibration, joint and position senses are normal.  This is also called dissociate anesthesia.
  • 34. Anterior spinal syndrome  Loss of pain, temperature and touch below a level on both sides with on both sides with preserved position, joint and vibration sense.  Eg. Anterior spinal artery thrombosis
  • 35. Posterior spinal syndrome  Loss of poosition, joint and vibration sense below a level with normal touch, a level with normal touch, temperature and pain senses.  Eg. Tabes dorsalis
  • 36. Brain Stem Syndrome  Loss of touch pain temerature on same side of the faceand opposite of the faceand opposite side of the body due to involvement of trigeminal tract or nucleus or spinothalamic tract.
  • 37. Thalamic syndrome  Loss of all modalities of sensations on the opposite side of body  Position sense are more  Position sense are more affected than the other sensation.  There may be spontaneous pain & discomfort of the most torturing and disabling type.