The best way to do that is to start by testing the most distal joint in the finger and the feet. You should stabilize the joint on the side. Don’t stabilize this way and don’t test this way. If you test AP, you get pressure sensation. We just care about joint position sensation. So, stabilize the distal joint and tell the patient, show him.
-“This is up, this is down, okay? Now close your eyes and tell me which way I’m moving it. Don’t you move it, just let me move it. Okay? Which way is it going?”
-“Down."
-“Up."
Just a millimeter of movement and he should be able to detect it.
-“That’s normal. Let’s see the other side."
-“Down."
-“Up."
Now, if you were to have an abnormal response, the next thing to do would be to test a more proximal joint.
-”Up."
-"Down.”
Okay, and you could go more proximal if he doesn’t get that. More proximal at the elbow, more proximal at the shoulder. The ultimate is a person doesn’t know where their arm is in space. For example, a large thalamic hemorrhage. But it is easier to feel the proximal than distal and if you get the normal distal sensation, you don’t need to test the rest. And one other point is, the wider you go, the easier it is for the patient to feel it, and the faster you go, the easier it is to feel it. So, a small, slow, subtle movement. If you can get that, if the patient gets that correct, everything else is normal. Let’s go to the toes now, and the same principle pertains.
-“Close your eyes. Tell me which way I’m moving your toe. Up or down?”
-“Down."
-"Up.”
-“Which way and I moving it, up or down?”
-“Up."
-"Down."
-"Down.”
There are those who would suggest that you always test three instead of two times for proprioception, because the chance the patient may get it right, you know, half the time. So, three times is less likely. Either way, he was correct in all responses.