Skin Sensitivity Disorders: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; furthermore:
    • Inspection (viewing).
      • Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes.
      • Gait (fluid, limping).
      • Body or joint posture (upright, bent, gentle posture).
      • Malpositions (deformities, contractures, shortenings).
      • Muscle atrophies (side comparison!, if necessary circumference measurements).
    • Auscultation (listening) of the heart.
    • Auscultation of the lungs
    • Palpation (palpation) of the abdomen (abdomen), etc.
  • Neurological examination – including testing of reflexes, gait/standing tests, checking of extremity/oculomotor function [due todifferential diagnoses:
    • Apoplexy (stroke).
    • Arteria spinalis anterior syndrome – when this artery supplying the spinal cord is occluded, various neurological symptoms may occur
    • Brown-Sequard syndrome – hemiplegic injury to the spinal cord associated with sensory disturbances.
    • Lesions in all areas of the central nervous system.
    • Nerve lesions (nerve damage), unspecified.
    • Polyneuropathy – generic term for certain diseases of the peripheral nervous system that affect multiple nerves – primarily small nerves in the arms and legs.
    • Spinal stenosis – narrowing of the spine with constriction of the spinal cord.
    • Syphilis – sexually transmitted infectious disease.
    • Tumors of the central nervous system, unspecified
    • Root syndromes – cervical or lumbar root syndrome.
    • Injuries to peripheral nerves or the central nervous system.
    • Paraplegic syndrome]
  • Psychiatric examination [due todifferential diagnoses:
    • Alcohol abuse
    • Psychogenic sensitivity disorder]

Localization of damaged structures and their distribution of sensory disturbances

Localization of damaged structures Distribution of sensory disturbances
Peripheral nerve lesion (peripheral nerves = nerves located outside the brain and spinal cord). Field-like in the corresponding supply area of the affected nerve
Peripheral nerve lesion (multiple nerves) Stocking- or glove-shaped sensory disturbances
Root lesion Striate in the corresponding dermatome (skin area autonomously supplied by the sensory fibers of a spinal nerve root/spinal cord root)
Spinal cord lesion Sensory level, dissociated sensory disturbance (= skin area with disturbed or abolished temperature and pain sensation, while touch sensation and depth sensibility are preserved)
Brainstem lesion Hemiplegic hypesthesia (decreased sensitivity of the skin), dissociated sensory disturbance
Cortical (“affecting the cerebral cortex”) lesion. Hemiplegic hypesthesia for all qualities

Square brackets [ ] indicate possible pathological (pathological) physical findings.