Sensory

• UL Touch, Pain, Proprioception test
• LL Touch, Pain, Proprioception Test

Peripheral Nerve Injuries

• Median nerve = atrophy of thenar emminence
• Ulnar nerve = atrophy of the hypothenar emminence

Sensory Pathways

Thalamic level general sensation - No fine distinctions

Neurons from thalamus to sensory cortex
here stimuli localized & discrimination

? Causative lesion patterns of sensory loss + motor findings

Spinothalamic Tract

• Pain and Temperature
• Crude touch (Light Touch without localization)
• Fibers cross & pass upward into thalamus

Posterior Columns

• Position and vibration
• Fine touch
• Synapse in medulla, cross & continue on to thalamus

Sensory specific testing

• Temperature
• Vibration
• Proprioception
• Tactile localization
• Discriminative sensations
  • Stereognosis
  • Graphesthesia
  • Two-Point Discrimination

The Sensory System

1. Meticulous mapping important

2. Compare distal & proximal

3. Stocking & glove sensory loss

   • polyneurpathy

4. Vibration sense

   • peripheral neuropathy
   • posterior column disease

5. Lesions of sensory cortex

   • astereognosis
   • inability to recognize numbers
   • decreased two-point discrimination
   • decreased point localization
   • extinction

Testing the nerves of the upper extremity

Testing the nerves of the upper extremity