Upper Limb Neuro
 

Sensory Assessment

 
 
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Overview

  • Sensation is a key aspect of the nervous system, and includes many different modalities. By thoroughly assessing the pattern of sensory loss it is possible to characterise and localise a central or peripheral nervous lesion.
    • Sensory Modalities

    • Dorsal column pathway - proprioception, vibration sensation, soft touch
    • Spinothalamic pathway - pain sensation, temperature sensation, soft touch
    • Causes of Sensory Loss

    • Central Nervous System

    • Brain lesion - ischaemia, haemorrhage, tumour, trauma, encephalitis, vasculitis, demyelination
    • Spinal cord lesion - infarct, haemorrhage, abscess, transverse myelitis
    • Peripheral Nervous System

    • Nerve root pathology - trauma, radiculopathy, neoplasm
    • Brachial plexopathy - trauma, tumour, brachial neuritis
    • Focal peripheral nerve pathology - trauma, entrapment, focal ischaemia, sarcoidosis, tumour
    • Mononeuritis multiplex - vasculitis, diabetic neuropathy, Lyme disease, leprosy, paraneoplastic, amyloidosis, sarcoidosis
    • Peripheral polyneuropathy - diabetic neuropathy, hypothyroidism, B12 deficiency, alcohol, paraneoplastic, Guillain-Barre, CIDP
    • Other

    • Poor compliance with examination
    • Interpretation

    • Sensory loss affecting an entire limb or entire side - likely due to central pathology
    • Sensory loss affecting a single dermatome  - likely due to spinal nerve root pathology
    • Sensory loss affecting a single peripheral nerve distribution - likely due to a focal peripheral nerve palsy
    • Sensory loss affecting multiple peripheral nerve distributions - potentially due to a brachial plexus lesion, or mononeuritis multiplex
    • Distal sensory loss (glove and stocking distribution) - suggests a peripheral polyneuropathy
    • Isolated dorsal column loss (impaired proprioception and vibration sensation with intact pain and temperature sensation) - suggests peripheral demyelination, e.g. Guillain-Barre, CIDP
 
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