Fig. 5.1
2015 Worksheet
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Sensory Testing
There are 28 key sensory dermatomes from each side of the body that are individually tested for light touch and pinprick modalities. The face is used as the normal control point.
A three-point scale is used to score light touch and pinprick sensation separately (see below).
Not testable (NT) is used when the key sensory point cannot be accurately scored because of a cast, burn, amputation, or if the patient is unable to appreciate sensation on the face .
- 2.
Pinprick (PP) testing
Using the sharp edge of a safety pin, sensation is compared to that of the face. The patient must be able to differentiate the sharp and dull edge of a safety pin.
Score
Definition
0
No sensation felt by the patient or unable to differentiate between the sharp and dull edge
1
The sharpness of the pin is not felt to the same degree as on the face, but able to differentiate sharp from dull
2
Pin is felt as sharp as on the face
NT
Not testable
- 3.
Light touch (LT) testing
A cotton tip applicator is used and sensation is compared to the face.
Score
Definition
0
Absent sensation
1
Altered (impaired or partial appreciation, including hyperaesthesia)
2
Light touch is felt and is the same as on the face
NT
Not testable
NOTE: It is very important to test the S4–S5 dermatome (ano-mucocutaneous junction) for light touch and pinprick sensation, as this is used to determine if the patient has a neurologically complete or incomplete injury.
- 4.
Deep Anal Pressure (DAP)
This is performed by applying gentle pressure to the anorectal wall with the examiners distal thumb and index finger while asking the patient if they perceive pressure in that area. Consistently perceived pressure should be graded as present or absent.
- 5.
ASIA Key Sensory Levels (See Fig. 5.1)
C2
At least 1 cm lateral to the occipital protuberance (alternatively 3 cm behind the ear)
C3
Supraclavicular fossa (posterior to the clavicle) and at the midclavicular line
C4
Over the acromioclavicular joint
C5
Lateral (radial) side of the antecubital fossa (just proximal to elbow crease)
C6
Thumb, dorsal surface, proximal phalanx
C7
Middle finger, dorsal surface, proximal phalanx
C8
Little finger, dorsal surface, proximal phalanx
T1
Medial (ulnar) side of antecubital fossa, just proximal to the medical epicondyle of the humerus
T2
Apex of axilla
T3
Third intercostal space (IS) (at midclavicular line)
T4
Fourth IS (nipple line) (at midclavicular line)
T5
Fifth IS, midway between T4 and T6 (at midclavicular line)
T6
Xiphoid, sixth IS (at midclavicular line)
T7
Seventh IS, at midclavicular line (midway between T6 and T8)
T8
Eighth IS, midway between T6 and T10 (at midclavicular line)
T9
Ninth IS, midway between T8 and T10 (at midclavicular line)
T10
Tenth IS at umbilicus (at midclavicular line)
T11
Eleventh IS, at midclavicular line
T12
Inguinal ligament at midpoint at midclavicular line
L1
Half the distance between T12 and L2
L2
Mid-anterior thigh at midpoint connecting T12 and medial femoral condyle
L3
Medial femoral condyle above the knee
L4
Medial malleolus
L5
Dorsum of foot at third metatarsal phalangeal joint
S1
Lateral heel (calcaneous)
S2
Popliteal fossa in the midline
S3
Ischial tuberosity or infragluteal fold
S4–S5
Perianal area <1 cm lateral to the mucocutaneous junction (taken as one level)
- 6.
Motor Strength Testing
There are ten key myotomes on the left and right sides of the body that are tested in the supine position:
Myotome
Muscle Action
C5
Elbow flexors (biceps, brachialis)
C6
Wrist extensors (extensor carpi radialis longus and brevis)
C7
Elbow extensors (triceps)
C8
Finger flexors (flexor digitorum profundus of middle finger)
T1
Small finger abductor (abductor digiti minimi)
L2
Hip flexors (iliopsoas)
L3
Knee extensors (quadriceps)
L4
Ankle dorsiflexors (tibialis anterior)
L5
Long toe extensors (extensor hallucis longus)
S1
Ankle plantarflexors (gastrocnemius, soleus)
- a.
Manual Muscle Testing Grading System
0
No movement (total paralysis)
1
Palpable or visible contraction but no movement
2
Active movement through full range of motion (ROM) with gravity eliminated
3
Active movement through full ROM, against gravity
4
Active movement, full ROM, against moderate resistance in a specific muscle position
5
Normal strength with full ROM
5*
(Normal) active movement, full ROM against gravity and sufficient resistance to be considered normal if identified inhibiting factors (i.e., pain, disuse) were not present
NT
Not testable (i.e., due to immobilization, severe pain such that the patient cannot be graded, amputation of limb, or contracture of >50 % of the ROM)Related posts:
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