The physical examination may be limited or extensive depending on the type of peripheral nerve disorder. This section provides information on the physical exam of a patient with a peripheral nerve injury. To that end, the section attempts to show all of the modalities available for patient examinations.
Physical Examination Topics:
General Examination and Assessment of Joint of Motion: This exam is used to generalize the issue at hand.
Motor Examination: Two motor examination modalities exist to assess muscle function.
- By Region: Shoulder, elbow, forearm, wrist, hand, etc.
- By Nerve: Axillary, musculocutaneous, radial, median, ulnar, etc.
Sensory Examination: This exam is used to confirm your motor findings if the injury is proximal and involves a motor component. Otherwise, this exam will help delineate the general location of the injury given the affected sensory nerve territory. Examination of sensory territories and dermatomes should be comprehended separately to reduce confusion.
- Sensory Territories
- Dermatomes
Provocative Tests: These tests are used to provoke a reaction in the patient in order to help determine the type and location of the injury.
- Tinel’s Sign
- Phalen’s Test
- Scratch-Collapse Test
************* More Tests **************
Actual Physical Examination: Performing every examination technique as described above is a lengthy process and may detract from the ability to distinguish the type and location of the injury. However, it is important to refine your examination to the issue at hand by first generalizing and then specifying the nature of the injury depending on the scenario. A few case scenarios are presented below:
Example 1 – Patient with sharp stab wound to radial index finger.
- Exam is limited to a motor and sensory evaluation.
- Confirm loss of sensation in the radial digital branch of the median nerve.
- Confirm normal motor function of the index finger with intact flexion/extension, etc.
Example 2 – Patient with complex closed brachial plexus injury.
- An extensive exam is required for this scenario.
- Motor examination is performed to determine what muscles are functioning and not functioning, often described as “what is in” and “what is out.”
- Sensory examination is performed to corroborate motor exam findings and hone in on root level injuries.
- Percussion is performed along the injured nerve fibers to gain information on degree of injury, level of injury, and progress of recovery.