SYSTEMIC EXAMINATION

SYSTEMIC EXAMINATION

Examination of sensory system

Sensory modalities to be tested are:

1.Touch Light

Light pressure

2. Pain Superficial

Deep pain I pressure pain

3. Temperature < Warmth

Cold

4. Sense of position, Sense of movement

5. Stereognosis

6. Vibration sense

7. Any abnormal sensations - parasthesia.

Precautions:

Before proceeding to the examination, explain to the subject, the nature of the test to be conducted, so as to get maximum cooperation from the subject. During examination ask him to close his eyes and do the tests on both sides of the body and compare. All sensations should be tested in all the areas of the body. Negative tests should be given in between.

1. Touch or tactile sensibility:

Light touch is tested by touching the skin surface using a wisp of cotton or a fine hair brush. Instruct the patient to say ‘Yes’ every time he feels the touch, with his eyes closed. Corresponding points on both sides of the body are. compared. Occasionally negative tests should be applied and ask him whether he can feel the touch.

Light Pressure touch: is tested by touching with a blunt object. (with head of a pin) without applying too much pressure.

Tactile localisation: When the subject says that he can appreciate the sense of touch, ask him to localise the site, by touching the corresponding site on the opposite side.

Tactile discrimination or two point discrimination

It is the ability to discriminate between 2 points touched simultaneously, as two separate points. This can be tested using blunt dividers or weber’s compasses. Ask the subject whether he is touched with one point or 2 points. A minimum separation of the two points by about 1 - 2mm is enough to be appreciated in highly sensitive areas like fingertip. Whereas a separation of about 5-6 cms is needed in less sensitive areas like back. This test is particularly useful in lesions of posterior column or parietal cortex and in some peripheral nerve lesions (carpel tunnel syndrome).

Abnormalities of touch sensation

1. Anaesthesia - Complete loss of touch sensation

2. Hypoaesthesia - Partial loss of touch sensation

3. Hyperaesthesia -Touch is perceived as pain, irritating ortingling sensation

4. Delayed conduction - Touch is appreciated only after some time

5. Defective localisation -Allochiria

2. Pain

Superficial pain: The point of a pin may be used to test this. Make sure that the patient is not confusing between pain and sharpness of the point. Even in the absence of pain sensation, the subject may be able to detect the sharpness of the point object.

 

Pressure pain: This is tested by squeezing the muscles or pinching the tendo achilles. In tabes dorsalis the most prominent sensory involvement is loss of pressure pain.

Analgesia - Absence of pain sensitivity

Hypoalgesia - Partial loss of pain sensitivity

Hyperalgesia - Increased sensitivity to pain

 

 

 

 

 

Reference on Medicinal plants  Part I

Reference on Medicinal plants Part II

 

reference on  Indian medicinal plants and its treatments.