Diseases of the nervous system : a text-book of neurology and psychiatry . existing analgesia. 62 METHODS OF NEUBOWOICAL EXAMINATION Ll- \K Fig. 23.—Cutaneous reflex zones of hyperalgesia, showing their relations with thespinal root segments and their vegetative nervous system connections. The dottedareas are to be referred to the internal surfaces. (After Dejerine.) EXAMINATION OF SENSORY NERVOUS SYSTEM 63 Deep Sensibility.—^Here deep pressure pain, muscle and joint senseand bony sensibility are to be tested. Deep pressure with the thumband fingers, or a special instrument (baresthesiometer),
Diseases of the nervous system : a text-book of neurology and psychiatry . existing analgesia. 62 METHODS OF NEUBOWOICAL EXAMINATION Ll- \K Fig. 23.—Cutaneous reflex zones of hyperalgesia, showing their relations with thespinal root segments and their vegetative nervous system connections. The dottedareas are to be referred to the internal surfaces. (After Dejerine.) EXAMINATION OF SENSORY NERVOUS SYSTEM 63 Deep Sensibility.—^Here deep pressure pain, muscle and joint senseand bony sensibility are to be tested. Deep pressure with the thumband fingers, or a special instrument (baresthesiometer), is used. Thepressure should be sufficient to cause pain. Muscle and joint sense are tested by first showing the patient thatone moves the thumb and big toe up or down—and then repeatingmovements up or down while the eyes of the patient are closed. Fur-ther, weights may be used and the ability to estimate differences Temporal (,D7) Vertical (,D8) Orbital (.D9, 3 Nasofrontal (C 3,4)TemiD or of rental {0 5,6) Maxillary -NasolabialMental arietal {DO) ccipital (.DIO). Superior LaryngealInferior Laryngeal Fig. 24.—Cutaneous reflex zones of hyperalgesia of the head, neck, and shoulders intheir relations to vegetative nerve (somatic) disturbances. (After Dejerine.) observed; or the patient is requested to imitate with one hand, adefinite position of the other hand. Bojiy sensibility is tested by a tuning fork of low vibrating capacity. Sensibility of the nerve trunks to direct pressure should then betested. In the upper arm the brachial plexus branches in the neckand under the arm are palpable and along the inner arm and elbow-joint one may reach the median, radial, and ulnar. Anesthesia of theulnar (Biernacki) is frequently a tabetic symptom. The radicular and peripheral sensory distributions are shown inFigs. 11,12,13,14,15,16. 64 METHODS OF NEUROLOGICAL EXAMINATION In the lower limb the sciatic, anterior crural, cutaneous femoris,tibialis, and superficial peroneus are palpa
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