TAILIEUCHUNG - Chapter 025. Numbness, Tingling, and Sensory Loss (Part 3)

Examination of Sensation The main components of the sensory examination are tests of primary sensation (pain, touch, vibration, joint position, and thermal sensation; Table 251). Table 25-1 Testing Primary Sensation Sense Test Device Endings Activated er Fib Size ral Cent Mediatin g Pathway Pain ick Pinpr Cutaneous nociceptors all Sm SpTh , also D Temperat ure, heat m object War Cutaneous for all Sm SpTh metal thermoreceptors hot Temperat ure, cold Cold metal object Cutaneous thermoreceptors cold for all Sm SpTh Touch Cotto Cutaneous ge small Lar Lem, n wisp, fine mechanoreceptors, brush also naked endings and also D and SpTh Vibration Tuni ng fork, 128 tors, Hz Mechanorecep especially ge Lar also D Lem, pacinian corpuscles Joint ve Passi Joint capsule and tendon endings, Lar Lem, position movement of specific muscle spindles ge also D joints Note: D, diffuse ascending. | Chapter 025. Numbness Tingling and Sensory Loss Part 3 Examination of Sensation The main components of the sensory examination are tests of primary sensation pain touch vibration joint position and thermal sensation Table 251 . Table 25-1 Testing Primary Sensation Sense Test Endings Fib Cent Device Activated er Size ral Mediatin Pathway g Pain Pinpr ick Cutaneous nociceptors Sm all SpTh also D Temperat ure heat War m metal object Cutaneous thermoreceptors for hot Sm all SpTh Temperat ure cold Cold metal object Cutaneous thermoreceptors for cold Sm all SpTh Touch Cotto n wisp fine brush Cutaneous mechanoreceptors also naked endings Lar ge and small Lem also D and SpTh Vibration Tuni ng fork 128 Hz Mechanorecep tors especially pacinian corpuscles Lar ge Lem also D Joint Passi ve Joint capsule and tendon endings Lar Lem position movement muscle spindles ge also D of specific joints Note D diffuse ascending projections in ipsilateral and contralateral anterolateral columns SpTh spinothalamic projection contralateral Lem posterior column and lemniscal projection general principles pertain. The examiner must depend on patient responses particularly when testing cutaneous sensation pin touch warm or cold which complicates interpretation. Further examination may be limited in some patients. In a stuporous patient for example sensory examination is reduced to observing the briskness of withdrawal in response to a pinch or other noxious stimulus. Comparison of response on one side of the body to the other is essential. In the alert but uncooperative patient it may not be possible to examine cutaneous sensation but some idea of proprioceptive function may be gained by noting the patient s best performance of movements requiring balance and precision. Frequently patients present with sensory symptoms that do not fit an anatomic localization and that are accompanied by either no abnormalities or gross inconsistencies on examination. The examiner should then .

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