Nerves Examination

Department Dermato-venereology FK-UNSRI/RS dr. Moh Hoesin Palembang 2008

Which nerves should you examine?

N. Auricularis magnus N. Ulnaris N. Medianus N. Radialis N. Peroneus communis N. Tibialis posterior N. Trigeminus N.. Fasialis

Is the nerve tender?

While you feel each nerve, look at the patients face to see if you are causing him pain

Remember that when you press very hard even a normal nerve will be painful

Is the nerve thickened?

While you feel each nerve, look at the patients face to see if you are causing him pain

Remember that when you press very hard even a normal nerve will be painful

N. Auricularis magnus
Great auricular nerve is first visualized by turning the head to one side The nerve stretches across the sternomastoid muscle Once visualized the patiet is asked to turn the head against the resistance os examiners hand hed on the chin, the nerves is palpated

N. Auricularis Magnus Examination

N. Ulnaris
Ulnar nerve lies above the olecranon posse Feel the right ulnar nerve with left hand ang left nerve wth right hand

N. Ulnaris Examination

N. Radialis

Radial nerve is palpated in the radial groove

N. Radialis Examination

N. Radialis

N. Medialis

The median nerve is palpated by flexing the elbow and the palpating deeply between he flexor tendon, at the wrist

N. Medialis

N. Peroneous communis
Common peroneal nerve is felt at the neck of fibula on both sides. The patient is asked to sit on the chair relaxed while palpation It is felt two centimeters below the head of fibula

N.Peroneous Communis Examination

N. Tibialis Posterior

Posterior tibial nerve is felt posterior and inferior to the medial malleolus

N. Tibialis Posterior

Lagophthalmos
Facial nerve branch to the eyelids

Lagophthalmos means paralysis of the eyelids so that they do not close completely

examination

Ask the patients to close his eyes ang keep them lightly close as if sleeping

Lagophthalmos
The patient is trying to close his eyes

Measure the gap between the eyelids. Here it is about 2 mm

Testing for anaesthesia

There are two reasons for testing for anasthesia To help with diagnosis and classification To decide whether there is a risk of future problems such as ulcers and other damage

Testing to help with diagnosis and classification

Where to test

Skin lesions - hands, feet, legs

What to use

Thin points of cotton wool

Testing to decide risk of future damage

Where to test

- Palms and soles of feet - Cornea

What to use

The points of pencil, piece of grass, a nylon monofilament (10 g)