Sensory System Upper Limb

Washes hands, appropriate dress and grooming. Introduces self, asks patient's name and age. Asks for consent.

 * *Wash hands(
 * Hello my name is [Medical Student] can I please get your full name and age please?
 * Mr. Doe, today my attending physician has asked me to check the sensory of the upper limbs, do I have your permission?

Explains procedure to patient, positions and drapes.

 * Mr. Doe, today I'll be touching various parts of your arms to make sure the feelings are intact, are you

comfortable with this?
 * I just want to remind you that anything we find today will be confidential.
 * Is there anything you need before we begin?
 * The patent is seated on the bed and is properly draped.

LIGHT TOUCH: Test for light touch of the upper limb bilaterally. Demonstrate a knowledge of the major dermatomes while performing task. Comment on findings and compares distal with proximal results.

 * Mr. Doe, I'm going to be touch your arm with this wisp of cotton, please say "now" when you feel the cotton on your arms.
 * Please close your eyes.
 * I'm going to perform Light Touch of the Upper Limb bilaterally from C3 to T2.
 * The patient was able to feel the cotton which suggest he does not have a polyneuropathy.
 * Absence of touch suggest anesthesia.
 * Decreased touch sensation suggest hypoesthesia.
 * And increased touch sensation suggest hyperesthesia.

PAIN: Test for pain bilaterally in the major dermatomes. Comment on findings.

 * Mr. Doe, I'm going to perform the same exam again using the pointy end of this instrument, please say "now" when you feel it on your arms.
 * Please close your eyes.
 * The patient was able to feel Pain in all dermatomes which is normal.
 * Absence of pain can suggest analgesia.
 * Decreased pain sensitivity can suggest hypalgesia.
 * Increased pain sensitivity can suggest hyperalgesia.

== VIBRATION: Check for vibration sense in thumb bilaterally using a 128 Hz tuning fork at the distal bony prominence of the thumb. Assess for ability to tell when vibration ceases. Comment on findings. ==
 * Mr. Doe, I'm going to put this tuning fork on your thumb, please say "now" when the vibration stops.
 * The patient was able to feel vibration which is normal.
 * Loss of vibration sense can suggest peripheral neuropathy caused by:
 * Diabetes
 * Tabes Dorsalis secondary to Syphilis
 * Vitamin B12 deficiency
 * Multiple Sclerosis

== PROPRIOCEPTION: Check for proprioception in the thumb bilaterally, holding the thumb laterally at distal phalange, and asking patient to close eyes. Give preview of upward and downward movement before testing. Comment on findings. ==
 * Mr. Doe, this is up, this is middle, this is down.
 * Please close your eyes and tell me which direction your thumb is in.
 * The patient was able to tell me the direction his thumb was in which suggest he does not have loss of proprioception.