Physical exam: Sensory system and reflexes exam

Question 1

Sensory system and reflexes exam: Learning objectives

Answer 1

1. Assess pain, T, light touch, and vibratory sensation
2. Assess position sense and discriminative sensation
3. Elicit deep tendon reflexes of biceps, triceps, brachioradialis, knee, and ankle
4. Properly test the plantar response or Babinski’s sign

Question 2

Dermatomes

Answer 2

C3: Front and back of neck
T4: Nipples
T10: Umbilicus
L1: Inguinal
C6: Thumb
C8: Ring and little fingers
L4: Knee
L5: Anterior ankle and foot

When pain sensation is abnormal, test with temperature tubes.

Question 3

Reflexes per etiology

Answer 3

• Thyroid disease: Biceps reflex (if hyporeflexic in upper, it will be in lower)
• Sciatica: Achilles and patellar
• Stroke: Biceps and patellar

Question 4

Reflexes and levels

Answer 4

• Biceps (C5, S6): Palm down, depress biceps tendon w/ finger. Use TIP of hammer.
• Brachioradialis (C6): Only if suspect C6 lesion. 1-2 inch above the wrist. Patient forearm resting on the lap. Use WIDE part of the hammer.
• Triceps (C7): Only if suspect C7 lesion. Hit above elbow. Use TIP of hammer.
• Patellar (L4*, L3, L2): Use TIP of hammer.
• Achilles (S1*, L5): Use WIDE part of the hammer.

Question 5

Reflexes: Reporting (Report numbers)

Answer 5

0: Absent
1: Weak (hyporeflexia)
2: Normal
3: Hyperreflexia