Now, we'll move to the
advanced sensory exam of the upper extremities. The first part of this
is to check each of the dermatomes with
superficial touch and superficial pain. I'm going to check
each of the dermatomes and compare them one side to another to ensure that each feel about the
same to the patient. What I'll do is, Mary, I'm going to touch you on
different parts of your arm, and I want you to tell me when you feel me touch
the first time. Then with the second touch
if it feels the same. Okay. For any parts of
the sensory exam, I will have the patient
close her eyes. It helps to prevent distractions
and helps me to say that she is actually feeling the touch as opposed to
seeing me touch her. Now, if you can close your eyes, tell me when you feel me touch. Yes. Same. What I'm checking is each one of the different dermatomes. That was C4 on the very
top of the shoulder. Now I'll move to C5. Yes. Same. All right. And
that's checking on the outside of the elbow. Now, if you can turn
your hands over, Mary, here. Now, C6. Yes. And that's on the thumbs. C7. Yes. Same. On the middle finger? Yes. Same. And that's C8, and that's on the little finger. And then T1. Yes. Same. And that's on the
inside of the arm. And now I'll move to
superficial pain, and I'll demonstrate for Mary what this is
going to feel like. I've broken a cotton
tipped applicator, and I'm going to use
the sharper end. Mary, I'm going to touch
you on your finger here, and that's what the
sharper touch feels like. Okay. I'll do the same thing
where I'll ask you if you feel me touch you and then
if it feels the same. Okay. All right. Yes. Same. So C4. Yes. Same. C5. Yes. Same. C6. Yes. Same. C7. Yes. Same. C8, and then
inside of the arm? Yes. Same. And that's T1. Those are the superficial touch and superficial pain sensations. The next part of the exam
is the vibratory sense. And I'm going to check distally on one finger on one hand and then one
finger on the other hand. As long as those are normal, you don't need to test
other areas as well. What I'm going to do is just lightly strike the tuning fork against my palm to have
it begin vibrating. Now, Mary, you can
close your eyes, and tell me what
this feels like. Vibration. And so I've asked the patient to tell me what it feels like, because if she says she
just feels pressure, then I know that her vibratory
sensation is not intact. Now, what I will do is I'll say, Okay, Mary, tell me
when this stops. And what I can do is artificially
stop the tuning fork. Stop. All right. Mary can tell me or I can tell that Mary's
vibratory sense is intact, not only she could tell when it started, but
when it finished. I'll do the same thing on
the other side here too. Notice I'm putting one finger
underneath her finger. What that does is it transmits
the vibration through her finger and I can tell
whether her sense is intact, because I can feel the vibration through her finger
onto my finger. Now, Mary, tell me
when you do feel. Vibration. Okay and tell
me when it stops. Stop. Okay. Again, vibratory sense intact of both
upper extremities. Now, the last part is
joint position sense. This is a very subtle
sense for patients. I'm going to tell Mary what it is I'll be doing
and then check it. Mary, I'm going to move
your finger either up or down and this
is going to be up, and then this is
going to be down. It's going to be more
subtle than that. Because this is
such a good sense, I can move very little of
the finger up and down, and Mary will be
able to sense it. You can close your
eyes and then tell me what direction I'm moving down. Down. Now I'm going to repeat that on the other hand here too. Down. Up. All right. And so she has intact joint
position since as well. That concludes the
advanced sensory exam of the upper extremities.