CHAPTER 5: Examination of Sensory Function C8 - On the dorsal surface of the proximal phalanx of the little finger.

By Alyssa Batas
T1 - On the medial (ulnar) side of the antecubital fossa, just proximally to the medial
epicondyle of the humerus.
- MOTOR
- efferent T2 - At the apex of the axilla.
- SENSORY T3 - Intersection of the midclavicular line and the third intercostal space
- afferent T4 - Intersection of the midclavicular line and the fourth intercostal space, located at the level
- THALAMUS of the nipples.
- responsible for filtering or segregating sensations T5 - Intersection of the midclavicular line and the fifth intercostal space, horizontally located
midway between the level of the nipples and the level of the xiphoid process.
SENSORY INTEGRATION T6 - Intersection of the midclavicular line and the horizontal level of the xiphoid process.
- organizes, interprets, use sensory T7 - Intersection of the midclavicular line and the horizontal level at one quarter the distance
- makes it possible to use the body effectively within the environment between the level of the xiphoid process and the level of the umbilicus.
- Control of Movement: T8 - Intersection of the midclavicular line and the horizontal level at one half the distance
> Feedback Control between the level of the xiphoid process and the level of the umbilicus.
- use sensory info to correct himself during the movement T9 - Intersection of the midclavicular line and the horizontal level at three quarters of the
> Feedforward Control distance between the level of the xiphoid process and the level of the umbilicus.
- pro-active strategy where in the pt corrects base on learning experience T10 - Intersection of the midclavicular line, at the horizontal level of the umbilicus.
SOMATOSENSATION
T11 - Intersection of the midclavicular line, at the horizontal level midway between the level of
- soma : body the umbilicus and the inguinal ligament.
- sensation from joints, muscles, skin
T12 - Intersection of the midclavicular line and the midpoint of the inguinal ligament.
RECEPTOR SPECIFICITY
L1 - Midway between the key sensory points for T12 and L2.
- high sensitivity to the type of stimulus for which they are designed
- at the distal end of afferent nerve fibers L2 - On the anterior medial thigh, at the midpoint of a line connecting the midpoint of the
inguinal ligament and the medial epicondyle of the femur.
- afferent fiber spinal nerve root spina cord brain stem thalamus highest center
of the brain L3 - At the medial epicondyle of the femur.
LABELED LINE PRINCIPLE L4 - Over the medial malleolus.
- specificity of a nerve fiber to a single modality of sensation L5 - On the dorsum of the foot at the third metatarsophalangeal joint.
- nerve fiber specificity S1 - On the lateral aspect of the calcaneus.
BELL MAGENDIE LAW S2 - At the midpoint of the popliteal fossa.
- all afferent stimulus will go through the posterior part
S3 - Over the tuberosity of the ischium or infragluteal fold
- all efferent stimulus will go through the anterior part
S4 and S5 - In the perianal area, less than one cm lateral to the mucocutaneous zone
AFFERENT IMPUSLES
B. Peripheral Nerve Distribution
- group of dermatomes
EFFERENT IMPULSES
- cutaneous nerves
Spinal Cord Tracts
_____________
- Anterolateral Spinothalamic tract
Pattern of Sensory Impairment
- detects harmful sensations
A. Dermatome
- slow conducting fibers
- skin area supplied by one dorsal root
A. Anterior Spinothalamic Tract
- transmits touch and pressure
C2 - occipital protuberance; behind the ear. B. Lateral Spinothalamic Tract
C3 - In the supraclavicular fossa, at the midclavicular line. - transmits pain and temperature
C4 - Over the acromioclavicular joint. - Dorsal Column Medial Lemniscus
C5 - On the lateral (radial) side of the antecubital fossa, just proximally to the elbow. - transmits more complex, discriminative sensation
- proprioception, kinesthesia, stereognosis, barognosis
C6 - On the dorsal surface of the proximal phalanx of the thumb.
C7 - On the dorsal surface of the proximal phalanx of the middle finger.
 PRELIMINARY CONSIDERATIONS B. Spinal Pathways
- Arousal, Attention, Orientation, Cognition - Anterolateral Spinothalamic Tract
A. Arousal - Dorsal Column Medial Lemniscus
- psychological alertness for activity TYPES OF SENSORY RECEPTORS
1. Alert A. Mechanoreceptors
- awake and attentive to normal levels of stimulation - cutaneous
2. Lethargic - all are sensitive to touch
- drowsy and may fall asleep if not stimulated - Free-Nerve Endings pain
3. Obtunded - Hair follicle endings -
- difficult to arouse from a somnolent state and frequently confused - Merkels Disc low sensitivity touch
when awake - Ruffini Ending heat
4. Stupor - Krause end bulb cold
- responds only to strong, generally noxious stimuli and returns to - Meissners Corpuscle touch
unconscious state - Pacinian Corpuslce pressure and vibration
5. Coma B. Deep Sensory
Muscle Receptors:
- cannot be aroused by any type of stimulation Attention
- Muscle Spindles
- repetition of numbers or spelling of words backward
- GTO stretch
B. Orientation
- Free Nerve Endings
- Person, Place, Time
- Pacinian Corpuscle
C. Cognition
Joint Receptors:
1. Fond of Knowledge
- Golgi type ending
- whole learning experience of the individual
- Free Nerve Ending
2. Calculation Ability
- Ruffinis Corpuslce
- dyscalculia
- Pacinian Corpuscle
3. Proverb Interpretation
C. Thermoreceptors
- Memory, Hearing, Visual Acuity
- cold and warm
A. Memory
D. _________
1. Immediate
E. Electromagnetic Receptors
- immediate registration and recall of info after an interval of few seconds
- Rods night
2. Recent
- Cones day
- short term memory
F. Chemoreceptors
- capability to remember current day to day events retrieving after several
- taste and smell
minutes
G. Blood CO2
3. Remote
- medulla
- long term memory
- aortic/carotid bodies
- recalling of facts/events that occurred years ago
B. Hearing
PT preparation
C. Visual Acuity
- testing environment
- Snellens Chart
- Peripheral Field Vision - Full explanation type and expectations
- inform the importance of cooperation
CLASSIFICATION
- do not guess
A. Sensory Receptors
- Trial Run
1. Superficial Receptors(Exteroreceptors)
- skin and Subcutaneous tissues Order of Examination
2. Deep Receptors (Proprioceptors) 1. Superficial Exteroreceptive)
- muscles, tendons, joints, ligaments 2. Deep Proprioceptive)
3. Combined (Cortical) Sensations 3. Combine Cortical
- two-point discrimination, barognosis 4. Distal to Proximal