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Physio 1

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9 views29 pages

Physio 1

Uploaded by

yakomo72
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Sensory Examination I

Spinothalamic Tracts
Classification of sensations

According to
route

Spinothalamic Dorsal column


tract tract

Ventral Lateral
Spinothalamic tracts carry:

Ventral Lateral
Crude
touch Pain

Crude
pressure Temperature

Itch and
tickle
In each sensation we have to comment on
Definition

Receptors
• Name and Type
• Mode of stimulation
• Adaptation

Nerve fibers

Tract

Perception

Test
Spinothalamic sensations
Crude Touch Temperature Pain

Ability of the body to It is unpleasant


Type of touch feel different degrees sensation caused
Definition poorly localized. of hot and cold by noxious
sensations stimulation

Cold: FNEs & Krause’s


FNEs
Receptors end bulb. FNEs
Hair end organs
Hot: FNEs

A & C→ cold, A → fast pain,


Afferent A and C
C → warm. C → slow pain.

Tract VSTT LSTT LSTT


Crude Touch Temperature Pain

Mechanical Change in metabolic Tissue damage →


deformity or rate of receptors K+, lactic acid,
Mechanism displacement of substance P, PG
receptors. (each 10o C). release.

Fine differences →
Fast pain → cortex.
Thalamus cortex.
Perception (Protopathic) Slow pain →
Wide differences→
Thalamus.
thalamus

Moderate
Adaptation Rapid (phasic) Tonic (no)
(hot> cold).

2 test tubes Pin prick


Test Cotton wool test
test Ischemic pain test
Adaptation
Aim of examination of sensory
system
• To ensure the integrity of the sensory
pathways and the sensory cortex.

• In each test we have to know


– Name.
– How it is done (General – Special).
– Comment.
General rules for Sensory examination

Patient Test

Explain the test for Bilateral systematic (e.g.


the patient. from distal to proximal).

Exposure (Areas to
be examined are All around or according to
devoid of clothes(. dermatomes.

Compare both sides (Apply


Ask the patient to the stimulus in the same
close his eyes. strength and the hand
should be supported).
Crude touch
Crude touch
Lost in: Tabes dorsalis, peripheral nerve lesion,
brain stem lesion.
Better felt in hairy skin than non hairy skin
(dorsum than palm of hands).
Why?
Cotton wool test
Cotton wool test
• Precautions:
- The cotton piece shouldn't be tapered.
- Touch the skin with the cotton and not wipe
it.
- Ask the patient what does he feel.
?
?
3rd Year Students
Checklist of Skill Exam
Crude Touch
Points of Evaluation Weight Marks
(in of the
marks) student
1 The student stood on the right side of the examinee. 1
2 The student explained the test to the examinee. 1
3 The student asked the examinee to uncover the part to be 1
examined.
4 The student asked the examinee to close his eyes. 1
5 The student used a piece of cotton (not tapered) to touch the 1
skin and ask the examinee what he feel.
6 The student repeated the test from distal to proximal 2
following the dermatomal rule
7 The student compared the examinee dermatomes on both 2
sides.
8 The student stated his findings 1
Total 10
marks
Pain

Fast • Pin Prick test


Slow • Ischemic pain test
Pain
• Lost in peripheral nerve lesion, syringomyelia.
• Its Loss is termed: Analgesia.
• Its exaggeration is termed: Hyperalgesia.
• Lesion in sensory cortex: loss of fast pain only.
• Lesion in thalamus: loss of fast & slow pain, then
return of slow pain only.
• Lesion in peripheral nerve & syringomyelia: loss
of fast & slow pain.
Pin Prick test
Pin Prick test

Precautions:
• Hold the pin between thumb and middle
finger and support the head of pin by index
finger
• Touch the skin with vertical pin rapidly.
• Repeated stimulation done with equal
strength .
3rd Year Students
Checklist of Skill Exam
Fast Pain
Points of Evaluation Weight Marks
(in of the
marks) student
1 The student stood on the right side of the examinee. 1
2 The student explained the test to the examinee 1
3 The student asked the examinee to uncover the part to be 1
examined.
4 The student asked the examinee to close his eyes. 1
5 The student used a sterile pin and handled the pin by his 1
thumb and middle fingers with the index finger fixing its
head (to give the same intensity).
6 The student repeated the test from distal to proximal 2
following the dermatomal rule
7 The student compared the examinee dermatomes on both 2
sides.
8 The student stated his findings 1
Total 10
marks
Temperature

Warm Cold
Temperature
Temperature
Distribution of thermoreceptors:
✓ Thermoreceptors are found in spots, not in
the form of separate receptors.
✓ Cold spots are more numerous than hot spots
by ~ 3-10 times.
✓ Thermoreceptors are more numerous in lips
(~20/cm2) than hands (~5/m2) than trunk
(~2/m2)
Two test tube test
Two test tube test
Precautions:
- We use 2 test tubes with warm and cold
water
- Use the tubes with irregular order so the
patient will not expect your next step.
?
Any Questions?

?
Activity
Thank you

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