Signs
 

Loss of Proprioception

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Overview

  • Proprioception is the sense of position and movement of the body in the absence of vision.
    • How to Elicit

    • Ask the patient to observe as you demonstrate upward and downward movement of the great toe. 
    • With their eyes closed, slowly move the joint over one to two seconds to the upward or downward position. 
    • Ask the patient to report whether the toe has been moved up or down. 
    • Repeat several times, and then repeat on the other side.
  • Hold the medial and lateral sides of the interphalangeal joint of the great toe, in order to avoid giving away tactile clues.
  • If proprioception is impaired at the great toe, repeat at the foot (Chopart's joint). If also impaired, repeat at the ankle, knee and then hip.
    • Causes of Isolated Vibration and Proprioceptive Loss

    • Demyelination - proprioceptive and vibration fibres are myelinated while pain sensation fibres are not.
    • Brainstem lesions involving the medial lemniscus
    • Dorsal spinal artery occlusion (unilateral impairment)

Dorsal Column Pathway

  • Cortical Centre
    Primary sensory cortex (postcentral gyrus)
     
     
    3rd Order Nuclei
    Ventral posterolateral (VPL) nucleus of thalamus
     
     
    Central Pathway
    Medial lemniscus
    Decussation
    Medulla
     
    2nd Order Nuclei
    Lower medulla - nucleus cuneatus (UL) / gracilis (LL)
     
     
    Spinal Pathway
    Dorsal column - fasciculus cuneatus (UL) / gracilis (LL)
     
    1st Order Nuclei
    Dorsal root ganglion
     
     
    Receptors
    Pacinian corpuscles / Merkel disc receptors / Meisner's corpuscles (vibration)
    Neuromuscular spindles (proprioception)
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