Nerve Function: Controls trapezius and sternocleidomastoid (SCM) muscles.
Inspection: Inspect the shoulders for asymmetry and atrophy
Trapezius Power: Ask the patient to shrug their shoulders against resistance
SCM Power: Ask the patient to turn their head to either side against resistance. Observe and palpate the SCM muscles.
Pain – Examination Technique:
- use a disposable pin.
- ask the patient to close their eyes and report whether they feel sharp or dull.
- be sure to apply the sharp stimulus to all sites since if only the dull stimulus is applied, pain sensation has not been assessed.
Temperature – Examination Technique:
- use a cold vibration fork.
- if necessary, the fork can be cooled by running it under cold water.
- ask the patient if they perceive the vibration fork as cold.
Components of the sensory examination:
- Light touch
- Pain and temperature
- Vibration sense
- Position sense
- 2 point discrimination
- Double simultaneous stimuli (extinction)
- patients should be sufficiently undressed but draped to preserve modesty.
- begin distally and move proximally and avoid calloused areas.
compare right to left.
- when necessary assess for a sensory level, peripheral nerve or dermatomal sensory impairment.
Extinction (Double simultaneous stimuli)
1. Tactile (sensory)
- with eyes open demonstrate to the patient that you will touch them on the left side, the right side or both.
- this should only be done if the patient can perceive a unilateral stimulus (i.e. if there is loss of pain and temperature or light touch on one side, there would be no point assessing extinction).
- have the patient close their eyes and as you deliver a gentle touch, report whether they feel it on the left side, right side or both sides.
2. Visual extinction
- wiggle a finger in the left, right or both visual fields and ask the patient to report where they see it.
3. Auditory extinction
- snap your fingers on the left, right or both sides and have the patient report where they hear the stimulus.
- when testing for extinction, it is important to deliver bilateral stimuli simultaneously with no time lag in between.