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Sensory and Other Physical Exam Modalities

Examination of sensation is important:

• It allows confirmation of motor exam findings regarding the level of the injury.
• It lets you find sensory-only functional deficits.

Abnormal sensation is often the first change to occur in patients with subacute nerve pathology such as compressive neuropathies.

Other provocative testing modalities such as Tinel’s sign, Phalen’s sign, and the scratch collapse test also provide valuable information that helps to elucidate the diagnostic dilemma.

There are many ways to test sensation.

Accepted measures include quick assessment of intact sensation to light, moving touch (using a cotton swab for example), two point discrimination (provides quantitative data but is time-consuming and difficult in many patients such as children) and ten testing (less commonly used but fast and often useful even in very young children).
Charts and Diagrams:
• These help track the collected data and are quite helpful:
• You can demarcate areas that correspond to dermatomes (useful for central nervous system or root level injuries).
• You can demarcate areas that correspond to specific nerves (useful in specific nerve injury patterns such as an ulnar nerve laceration). 
• One suggestion is to have the patient draw out areas of decreased sensation first, this will allow the examiner to hone in on the areas affected, confirm the sensory finding and quickly document; we use the front page of the pain evaluation sheet for this.
Provocative test and physical exam maneuvers can then help confirm the diagnosis and influence choice of further diagnostic work up and surgical management.