Neurological tests
Finger–nose test
Hold your finger about an arm’s length from the patient. Ask the patient
to touch your finger with their index finger and then touch their nose,
repeating the movement back and forth. Patients may demonstrate past
pointing (missing your finger) or intention tremor.
Indicates: possible cerebellar dysfunction.
Heel–shin test
With the patient lying down, ask them to place one heel on the opposite
knee and then run the heel down the tibial shaft towards the ankle and
back again. Patients may demonstrate intention tremor, an inability to
keep the heel on the shin or uncoordinated movements.
Indicates: possible cerebellar dysfunction.
Hoffman reflex
Flick the distal phalanx of the patient’s third or fourth finger. Look for
any reflex flexion of the patient’s thumb.
Indicates: possible upper motor neurone lesion.
Joint position sense
Test the most distal joint of the limb, i.e. distal phalanx of the index
finger or interphalangeal joint of the hallux. With the patient’s eyes
open, demonstrate the movement. To test, get the patient to close their
eyes. Hold the joint to be tested at the sides between two fingers and
move it up and down. Ask the patient to identify the direction of
movement, ensuring that you are not moving more proximal joints or
brushing against the neighbouring toes or fingers. If there is impairment,
test more proximal joints.
Indicates : loss of proprioception.
Finger–nose test
Hold your finger about an arm’s length from the patient. Ask the patient
to touch your finger with their index finger and then touch their nose,
repeating the movement back and forth. Patients may demonstrate past
pointing (missing your finger) or intention tremor.
Indicates: possible cerebellar dysfunction.
Heel–shin test
With the patient lying down, ask them to place one heel on the opposite
knee and then run the heel down the tibial shaft towards the ankle and
back again. Patients may demonstrate intention tremor, an inability to
keep the heel on the shin or uncoordinated movements.
Indicates: possible cerebellar dysfunction.
Hoffman reflex
Flick the distal phalanx of the patient’s third or fourth finger. Look for
any reflex flexion of the patient’s thumb.
Indicates: possible upper motor neurone lesion.
Joint position sense
Test the most distal joint of the limb, i.e. distal phalanx of the index
finger or interphalangeal joint of the hallux. With the patient’s eyes
open, demonstrate the movement. To test, get the patient to close their
eyes. Hold the joint to be tested at the sides between two fingers and
move it up and down. Ask the patient to identify the direction of
movement, ensuring that you are not moving more proximal joints or
brushing against the neighbouring toes or fingers. If there is impairment,
test more proximal joints.
Indicates : loss of proprioception.
