Sensory Examination
J. Terrence Jose Jerome in Clinical Examination of the Hand, 2022
Two-point discrimination, localization and the Moberg pick-up test are functional tests to assess sensation quality [9]. The function test helps find prevention, daily living activities recognizing and manipulating objects with vision occluded. Two-point discrimination is the ability to distinguish two points simultaneously applied to the skin and most helpful in the fingertips to quickly test normal versus abnormal sensation. The normal minimal distance is 3 cm for the hand or foot. With the patient's eyes closed, the examiner uses a pair of measured callipers or a bent paperclip to randomly touch the patient with either one or two points and indicate whether one or two points are perceived. Always compare the test with the opposite sides of the body. The following are the normal distances at which two points can be discriminated on various body parts:
Pediatric hand trauma
David E. Wesson, Bindi Naik-Mathuria in Pediatric Trauma, 2017
The digital nerves travel on the volar aspect on each side of the fingers. Sensation from these nerves is ideally tested using the two-point discrimination test. This is accomplished by bending a paper clip so its tips are about 5 mm apart, as normal two-point discrimination is less than or equal to 5 mm. On both the radial and ulnar side of each digit, touch the child’s finger with just enough pressure to cause skin blanching with either one or two points. Inability to discriminate one point from two with repeated testing may indicate an injury. However, it should be emphasized that in children it is often difficult to obtain the degree of attention and cooperation necessary to perform this exam reliably. In these situations, when the location of the injury makes nerve transection likely, operative exploration is recommended.
Hand trauma
Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou in Orthopaedic Trauma, 2014
Testing sensation may help to differentiate a higher lesion in the nerves, plexus or even the spine. Sensory loss should be examined with two-point discrimination and light touch. The median nerve can be compressed at the carpal tunnel following a distal radius fracture.Ulnar nerve compression can occur at Guyon’s canal with fractures of the hamate.Radial nerve injuries predominately occur proximal to the wrist.Digital nerve injuries are common with finger lacerations.
Clinical effects of resurfacing fingertip amputations in long fingers using homodigital dorsal neurofascial broaden pedicle island flaps
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Zhongqing Ji, Rongjun Nie, Shiyan Li, Chuancheng Liu, Bin Wei, Chunyong Zhu
Mean Semmes Weinstein monofilament score in the flap was 3.89 ± 0.37 g (range: 3.6–4.56 g, contralateral side 3.18 ± 0.39 g, range: 2.83–3.61 g, p < 0.05). Mean Semmes Weinstein monofilament score at the donor site was 3.22 ± 0.40 g (range: 2.83–3.61 g) (contralateral side 3.00 ± 0.33 g, range 2.83–3.61 g, p < 0.05). Mean values for static two-point discrimination in the flap was 5.6 ± 1.2 mm (range: 4–8 mm), including 9 excellent and 9 good results (contralateral side: 3.7 ± 0.8 mm, range: 3–5 mm, p < 0.05). Mean values of the static two-point discrimination in the donor zone was 4.3 ± 0.6 mm (range: 4–6 mm), including 17 excellent and 1 good results (contralateral side. 3.6 ± 0.6 mm, range 3–5 mm, p > 0.05). Mean quick dash scores was 5.81 (range: 0–20). Mean VAS score in the flap and donor site was 0.7 (range: 0–4) and 0.2 (range: 0–2) (Table 3).
Lifetime vibration dose correlates with severity of the neurological component of hand-arm vibration syndrome among tyre shop workers in Kelantan, Malaysia
Published in International Journal of Occupational Safety and Ergonomics, 2021
Asraf Ahmad Qamruddin, Nik Rosmawati Nik Husain, Muhd Yusof Sidek, Muhd Hafiz Hanafi, Zaidi Mohd Ripin, Nizam Ali
In the second phase of data collection, all subjects were invited to Hospital Universiti Sains Malaysia in Kelantan, Malaysia. Three specific hand function assessments were carried out: the Purdue pegboard test (Lafayette, USA) for hand dexterity examination, the Semmes-Weinstein monofilament test (Stoelting, USA) for finger sensation measurement and the two-point discrimination test (McKesson, USA) for tactile discrimination measurement. For the Purdue pegboard test, the discrimination threshold for an abnormal finding was 1 SD below the normative population mean for male maintenance and service employee data (15.49 for right hand, 15.25 for left hand, 12.31 for both hands, 43.04 for right + left + both and 38.71 for assembly) [16]. The Semmes-Weinstein monofilament test was recorded as abnormal if the subject’s threshold response was 3.61 mm and above [17]. For the two-point discrimination test, any value at and above 6 mm was recorded as abnormal [17]. The severity of the neurological component of HAVS was then staged according to the Stockholm workshop scale criteria. The LVD (m2 h3 s−4) was then calculated according to the equation [18]: ahv = total vibration value for the impact wrench; thi is the daily vibration exposure duration of each subject (h/day); tdi is the number of working days/year for each subject; tyi is the total number of years of use for each subject.
Perspectives on tactile intervention for children with cerebral palsy: a framework to guide clinical reasoning and future research
Published in Disability and Rehabilitation, 2018
Megan L. Auld, Leanne M. Johnston
Tactile treatment is often found “sneaking in the door” with upper limb movement training. Some treatment approaches, such as constraint induced movement training (CIMT) or BMT involve providing movement-focussed therapy with a secondary anticipation that tactile function may also improve by opportunistically sneaking in the door as motor output occurs. Four studies investigating CIMT or BMT in children with CP have investigated tactile performance before and after intervention. Three studies showed no statistical improvement in tactile performance. In the first study, children showed no improvement in two point discrimination following a two-week intensive CIMT block (70–84 hours) plus six months of home program [18]. In a second study, improvements in two point discrimination in the impaired hand were shown after six hours of CIMT, however, this was not examined statistically [19]. In a more recent study, 60 children were randomised to either 60 hours of CIMT or BMT, with both groups demonstrating no improvement in two-point discrimination or stereognosis [20]. Thus it seems that even at high doses, tactile stimuli unintentionally sneaking in the door with CIMT or BMT leads to very limited or no improvement in tactile performance.
Related Knowledge Centers
- Somatosensory System
- Tibia
- Dermatome
- Skin
- Psychophysics
- Neurological Examination
- Nerve
- Stimulus
- Dorsal Column–Medial Lemniscus Pathway