Upper Limb Sensation Examination Explained - Clinical Skills - Dr Gill

Hello, my name is Dr. Gill. I've been asked to do an examination of the sensation of your upper limbs. Before I start, can I please confirm your name and date of birth? Okay, it's Yamina that I know. 30th of September, 1996. Thank you very much. So, in terms of doing the examination, I'm going to be using a tuning fork, a neurotip, a cotton wool, and a neurofilament to test your sensation. Two of them are going to be doing the same thing, so the neurofilament and the cotton wool are very similar, but we're going to use those for demonstration purposes. So, if we start off with a neurofilament, these are specifically designed to bend at a set mass. So, this, it will bend with a weight of 10 grams. Therefore, I know that I'm using the correct force because it's bent, and thus the patient is always having the same sensation or the same load throughout the examination. A 10-gram filament is very important because this allows us to test for diabetic neuropathy. So, to start off, we're going to check, demonstrate the patient. So, keep your eyes open. I'm just going to touch your neck. Can you feel that? Yes. Fantastic. The patient is now aware of the sensation that they're going to experience, and they've seen it. We're going to ask them to close their eyes in order to reduce any additional inputs that might get us a false negative. So, if you close your eyes for me. And then, at this point, we're going to check over the dermatome. We're going to start off at the top, C4, and move down. I will highlight what we're testing as we do so. And we're going to ask the patient to say yes as soon as they feel the neurofilament. So, please say yes when you feel me touch you. Yes. That's C4. And we must make sure we check on the opposite side as well. We're going to go lower down to the mid-humerus, checking for C5. Yes. Okay. Yes. Then we can do C6, which is going to run on the inside of the arm here. Yes. All the way down to cover the thumb. Then we're going to ask the patient to turn their hands over. And then we're looking at C7, which covers the central part of the palm and the middle finger. Yes. And at those two points, I'm checking the most peripheral position, because if we had a peripheral neuropathy, we'd expect to start at the ends and then work forwards. We're then going to move to C8. Yes. Checking over the little finger. And then moving further up on the inside of the arm now, with the palms facing upwards, we're going to check for T1. Yes. And if you could move your arm slightly to the side so I can get to the inside of the humerus, checking for T2. Yes. Super. So we haven't found any abnormalities using this, and then we're going to move on to the next aspect of testing. So we're going to essentially do very similar, now using cotton wool. And in terms of doing crude touch, we're looking at assessing the anterior spinothalamic tracts, which we'll do with the cotton wool. So with the patient's eyes open, we're going to check at the neck. Yes. So the patient is aware of the sensation, and we're going to repeat in those same locations. So if you could keep your eyes closed for me, please. So C4. Yes. C5. Yes. C6. Yes. And if you could turn your hands over for me. C7. Yes. And C8. Yes. T1. Yes. And then if you could move your arms apart slightly. Yes. And T2. So discarding the cotton wool, we're then going to take the NeuroTip, making sure we've got a nice neon. So we're going to make sure the patient is aware of what this is and what's going to happen. So this is a bluntened needle, so it won't be painful, but if I'm going to touch the top of your neck, she'll feel a sharpness. Okay. So we're going to use exactly the same locations as we've just done before. So C4. C5. C6. Yes. If you could turn your hands over for me. C7. Yes. C8. Yes. And the inside of the forearm, T1. Yes. And then moving arms slightly to the side for T2. Yes. So we've got no abnormalities and we make sure we discard the NeuroTip. So that's the neurofilament and the cotton wool testing the anterior spinothalamic tracts. We've then gone over to pain with the NeuroTip, checking for the lateral spinothalamic tracts. We're then going to take the 128 hertz tuning fork to test for the dorsal columns. So in terms of that, we're going to strike the tuning fork, have the vibration, and we're going to place it to the patient's chest. You can feel that vibration. And when I do such, it stops. So we're going to check over the distal phalanx of the thumb, striking the tuning fork and placing it over the thumb. Now obviously the patient isn't going to feel the sensation I've touched, but we want to have the patient say when the vibration stops. So please tell me when the vibration disappears. It stops. Super. And we'll do the same again on the opposite side. And tell me when it disappears. Super. Thank you very much. I'm just going to try and test a temperature sensation now. So this is cold. Yes. And this is warm. Certainly not cold. So I'm going to ask you to close your eyes and tell me which you can feel. Cold. Okay. And what can you feel now? Okay. So we have the difference in the two, and we'll test on the opposite side. Super. Thank you very much. So we've confirmed there we've got intact sensory modalities to all three forms of testing. So we've got a normal upper limb sensory response. Now we would finally complete with proprioception. So proprioception being the body's ability to sense itself in time and space. So we're going to use the patient's thumb, and I'm going to get my thumb and index finger to hold either side of the nail, and I'm going to have the patient's eyes open as I'm moving the finger, and I'm going to stop in one position. I'm trying very hard to make sure the pressure is at the sides of the thumb, not top and bottom. So again, I'm not giving extra stimulation. So this is up, and this is down. I'm going to waggle your thumb. Please tell me what position I stop it in. Close your eyes, please. And it's always reasonable to test a couple of variations so we know the patient is giving such an answer. Do the same again on the side. So keep your eyes closed. That is up, and that is down. So wiggling. Which way is that? Down. Up. Up. Fantastic. Thank you very much. So we have no abnormalities here and no concerns from the sensory aspect of the upper limb neurological examination. If we can help you with your clinical skills, please put any questions down below, and we'll see what we can do to help you out there. Take care, and we'll see you in the next one. Cheerio.