(b) To assess shoulder and scapulae resistance, ask the patient to
extend both arms out in front of him and resist the push that you will apply. Try to push the
patient's arms down. This is a common site for sports injuries, arthritis, and bursitis. Ask
the patient to raise both arms above his shoulders. Try to push his arms down to his
sides. Instruct the patient to resist your efforts.
(c) Assess the lower extremities in a similar manner with the patient lying
down. Ask the patient to raise his leg against your hand, which is applying pressure on the
thigh, trying to flatten the leg. Ask the patient to flex his knees so that his feet are flat on
the table. Place your hands laterally at both knees. Note any pain with this movement.
(4) Sensation. The sensory functions include touch, pain, vibration, position,
temperature, and discrimination. If the patient complains of numbness, peculiar
sensations, or paralysis, sensation should be checked more carefully over flexor and
extensor surfaces of the extremities. Generally the face, arms, legs, hands, and feet are
tested for touch and pain.
(a) Touch is tested with a wisp of cotton. Ask the patient to close his
eyes and respond whenever the cotton touches his skin. Compare the sensation in
symmetrical areas of the body, such as the cheeks.
(b) Test the sharpness or dullness of pain by using the pointed and the
blunt end of a safety pin. Ask the patient to close his eyes and identify which end of the
pin is touching him. Compare distal and proximal areas and note any areas of reduced or
(c) The sense of vibration is tested with a tuning fork held firmly against a
bone. Bones commonly used are located at the thumb side of the wrist, the outside of the
elbow, either side of the ankle, and the knee. Test the distal bones of an extremity first.
Strike the tuning fork fairly hard and hold it against the patient's skin. The patient should
feel the vibration or buzz.
(d) The middle finger and large toe are used to test the sense of
position. Ask the patient to close his eyes. While supporting the patient's arm with one
hand, grasp the patient's middle finger firmly between the thumb and index finger of
your other hand. Exert the same pressure on both sides of the patient's finger while
moving it. To test the sense of position using the large toe, place the patient's heels on
the examining table and grasp the toe in the same manner. Use a series of brisk up,
down, and straight out movements before coming to rest in one of the three positions.
Ask the patient to identify the position.
(e) Temperature sensation is determined by touching the patient's skin
with tubes filled with hot and cold water. Ask the patient to identify which tube feels hot
and which feels cold. This test is unnecessary if the "sensation of pain" test is normal.