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