Sensation
Intact sensation is required for normal movement and function. Generally this is best tested in supine lying and is often part of the initial ward assessment. Having established the major abnormalities and their implications for treatment it is not necessary to repeatedly retest these, but an overall awareness is recommended.
Tactile awareness
Light touch and deep pressure may be assessed by placing your hand on the patient’s skin working from proximal to distal. If the patient cannot detect firm stroking stimuli (i.e. gross touch) then assessing light touch is usually pointless. In that case try tapping on bony points such as the knee cap and the elbow. If the patient is aware of firm touch then progress to light stroking with the finger tips or cotton wool to establish the degree of fine sensory loss. It is important to also test both sides simultaneously to establish whether the patient can perceive touch on both sides simultaneously.
Proprioception
Proprioception describes the perception of both joint movement and joint position. Joint motion awareness may be tested by supporting the limb and passively moving one joint at a time while the patient closes their eyes. Ask them first to report whether the limb is “still” or “moving” and if they are aware of the movement then to localise to which joint. Alternatively hold the thumb or great toe, tell the patient that flexion is “down” and extension is “up” and to report which direction they perceive the movement to be.
Joint position sense may be tested by asking the patient to copy the posture achieved passively by the tester on the affected side, with the limbs of the unaffected side. The patient should have their eyes closed during the test.
A useful global test of proprioception in the upper limb involves asking the patient to grasp the thumb of the affected hand with the un-affected hand while the tester moves the affected arm into different positions (with care of the shoulder). Initially the patient can look to see where the limb is to allow an appropriate understanding of the test, but they should have their eyes closed during the test.
Page last reviewed: 01 Feb 2021
