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.
- Inspection (viewing).
- 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.
