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Peripheral Nerves Examination

Peripheral Nerves Examination 

by Ayaz Mehmood

Median, Ulnar, Radial, Tibial and Common Peroneal Nerve.

This is a scheme I have just developed myself. Thought it might help you.

Median Nerve:

- Palpate muscles of forearm
- Check tone at wrist
- Ask the patient to make a fist (note wrist deviation)
- Ask him to hold your fingers tightly
- Flex your fingers at Metacarpophalangeals and straighten (show the patient yourself)
- Move the thumb in all planes
- Touch your finger tips with your thumb
- Abduct wrist
- Do Hoffman and finger flexor reflex
- Don't forget the sensory exam and that includes graphaesthesia and streognosis!
- Try tapping over carpal tunnel and ask for paraesthesias

Ulnar Nerve:
- Palpate muscles of forearm 
- Check tone at wrist 
- Make a fist
- Hold my fingers tightly
- Gently tap the table with all fingers
- Flex your fingers at MP and straighten them
- Abduct and then adduct your thumb
- Adduct wrist
- Fan out your fingers
- Now place a card in between two fingers and ask to hold it, while you try to snatch it away
- And don't forget the sensory exam again! Be sure to do it as medially as possible on the palm of hand

Radial Nerve:
- Palpate extensor muscles of arm and forearm
- Check tone at elbow and wrist
- Check power at elbow and wrist against resistance
- Do triceps and brachioradialis reflexes
- Make a fist (you are looking at how stable the fist is - Radial nerve is very important for that)
- Move thumb in all planes
- Extend wrist
- Extend your fingers

Tibial Nerve:
- Inspect leg muscles
- Palpate these muscles of posterior leg
- Check tone, power, ankle jerk and clonus at ankle.
- Evert & invert foot against resistance
- Ask patient to stand on tip-toes, and walk normally
- Flex toes and especiall great toe
- Check the normality of arches of feet
- Now do foot sensory exam on palmar side and Babinski reflex

Common Peroneal:
- Inspect foot for foot drop
- Extend foot and check power, against resistance
- Check tone, power, evert/invert foot
- Extend all toes
- Check Babinski
- Ask patient to walk (see if his foot drags along the surface)
- And conclude with sensory exam of lateral leg and dorsal foot surface


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