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Sensory Exam by Root

Exams and Signs

Description

  • Nerve compression syndromes are characterized by dysfunction of the nervous system at the spinal cord or nerve root level.1
  • Signs of cervical root involvement are indicated by pain with neck range of motion (ROM).2
  • In cases of cervical (C6–8) radiculopathy, patients experience dysfunction of a spinal nerve root.
  • In cases of cervical myelopathy, patients experience compression of the spinal cord.1

Pathophysiology

  • Neuropathy occurs when compressive pressures surpass those normally tolerated by the affected nerve.2
  • Neuropathy can arise from carpal tunnel syndrome, cubital tunnel syndrome, cervical radiculopathy or cervical myelopathy.1
  • In some cases, chronic neuropathy may be related to conditions such as diabetes or hypothyroidism.3

Instructions

  1. Ask the patient if s/he has experienced headaches, neck pain or upper back discomfort1
  2. Evaluate the patient for weakness, dysesthesias and pain with neck ROM
  3. Check for numbness or decreased sensation in the C6, C7 and C8 root areas. Be sure to include the volar and lateral aspect of the hand, the volar thumb/index/long and radial half of the ring fingers and the distal dorsal aspect of the thumb/index/long and radial half of the ring fingers. (SEE PHOTOS BELOW)

Variations

  • If treating a young child or an unconscious patient, sensory tests will not be possible, so the hand(s) must be immersed in water to test the “pruning reflex.”2 This may not be practical in emergency situations.

Related Signs and Tests

  • Sensory exam by nerve
  • Phalen test
  • Tinel’s test
  • Spurling’s maneuver
  • Cervical spine imaging
  • Electromyography
Presentation Photos and Related Diagrams
  • C5 Sensation
    C5 Sensation
  • C6 Sensation
    C6 Sensation
  • C7 Sensation
    C7 Sensation
  • C8 Sensation
    C8 Sensation
Definition of Positive Result
  • A positive result occurs when the patient reports numbness (absent sensation) while doing tested with light touch, pin, two point discriminator or vibration (tuning fork).
Definition of Negative Result
  • A negative result occurs when the patient reports normal feeling (normal sensation) while doing tested with light touch, pin, two point discriminator or vibration (tuning fork).
Comments and Pearls
  • It is often important to simultaneously test a defintiely normal area of sensation like the opposite hand, forearm or even the face so that the patient can properly identify and distinguish the diffeence between normal sensation and mild to mederately decreased sensation (felling) in the area with questionable sensory nerve function.
  • Prolonged compression neuropathy can result in intraneural edema, nerve demyelination and interfascicular fibrosis.2
  • The most important nerve sensory areas to test are the median nerve sensation, ulnar nerve sensation and to a lesser extent radial nerve sensation.
  • When testing radial nerve function, the examiner should rely more on motor testing than sensory testing.
  • Remember the most common monoradiculopathies involve C7 nerve root (long finger sensation), followed by C6 (thumb & index finger sensation).
Diagnoses Associated with Exams and Signs
References
  1. Micev AJ, Ivy AD, Aggarwal SK, et al. Cervical Radiculopathy and Myelopathy: Presentations in the Hand. J Hand Surg Am 2013;38(12):2478-81. PMID: 24054072
  2. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple. New Jersey: SLACK Incorporated, 2012
  3. Doyle JR. Hand and Wrist. Philadelphia: Lippincott Williams & Wilkins, 2006
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