Nerves Examination

Department Dermato-venereology
FK-UNSRI/RS dr. Moh Hoesin
Palembang
2008
Which nerves should you examine?
 N. Auricularis magnus
 N. Ulnaris
 N. Medianus
 N. Radialis
 N. Peroneus communis
 N. Tibialis posterior
 N. Trigeminus
 N.. Fasialis
 Is the nerve tender?

While you feel each nerve,

look at the patient’s face to see if you are causing him pain

Remember that when you press very hard even a normal nerve
will be painful
 Is the nerve thickened?

While you feel each nerve,

look at the patient’s face to see if you are causing him pain

Remember that when you press very hard even a normal nerve
will be painful
 N. Auricularis magnus
 Great auricular nerve is first visualized by
turning the head to one side
 The nerve stretches across the
sternomastoid muscle
 Once visualized the patiet is asked to turn
the head against the resistance os
examiner’s hand hed on the chin, the
nerves is palpated
N. Auricularis Magnus Examination
 N. Ulnaris
 Ulnar nerve lies above the olecranon
posse
 Feel the right ulnar nerve with left hand
ang left nerve wth right hand
N. Ulnaris Examination
 N. Radialis
 Radial nerve is palpated in the radial
groove
N. Radialis Examination
N. Radialis
 N. Medianus
 The medianus nerve is palpated by flexing
the elbow and the palpating deeply
between he flexor tendon, at the wrist
N. Medianus
 N. Peroneous communis
 Common peroneal nerve is felt at the neck
of fibula on both sides.
 The patient is asked to sit on the chair
relaxed while palpation
 It is felt two centimeters below the head of
fibula
N.Peroneous Communis Examination
 N. Tibialis Posterior
 Posterior tibial nerve is felt posterior and
inferior to the medial malleolus
N. Tibialis Posterior
 Lagophthalmos
Facial nerve – branch to the eyelids

Lagophthalmos means paralysis of the eyelids so that they do not close completely

examination

Ask the patients to close his eyes ang keep them lightly
close as if sleeping
 Lagophthalmos
The patient is trying to close his eyes

Measure the gap between the eyelids. Here it is about 2 mm

 Testing for anaesthesia
There are two reasons for testing for
anasthesia
 To help with diagnosis and classification
 To decide whether there is a risk of future
problems such as ulcers and other
damage
Testing to help with diagnosis and classification

Skin lesions
Where to test - hands, feet, legs

What to use Thin points of cotton wool

Testing to decide risk of future damage

- Palms and soles of feet

Where to test - Cornea

What to use The points of pencil, piece of grass,

a nylon monofilament (10 g)
 GANGGUAN FUNGSI SYARAF TEPI

SENSORIK MOTORIK OTONOM

ANESTHESI / KELEMAHAN
MATI RASA GG KEL MINYAK,
OTOT KERINGAT,CIRC
DARAH
TANGAN CORNEA JARI, TANGAN,
REFLEK
KAKI MATA KAKI LEMAH /
KEDIP (-)
MATIRASA MATIRASA LUMPUH
KULIT KERING /
PECAH-PECAH
LAGOPTH TANGAN/KAKI
LUKA INFEKSI ALMUS KITING,
BENGKOK
LUKA/ULCUS
INFEKSI
BUTA
MUTILASI /
ABSORBSI MUTILASI /
INFEKSI
ABSORBSI
BUTA
Pemeriksaan fungsi saraf
Facialis
Pemeriksaan raba Saraf
Ulnaris
Pemeriksaan fungsi motorik
Saraf Medianus
Pemeriksaan fungsi motorik

Saraf Ulnaris
Pemeriksaan fungsi motorik
Saraf Radialis
 Pemeriksaan Rasa Raba
tangan (fungsi sensoris saraf
ulnaris dan medianus)
 Pemeriksaan perabaan
saraf Peroneus Communis
Pemeriksaan perabaan
Saraf Tibialis Posterior
 Pemeriksaan fungsi
saraf Peroneus Communis
 Pemeriksaan fungsi
sensoris saraf Tibialis
Posterior
 Adakah Nodul ulcerasi ?
 Adakah bercak aktif /
bengkak didaerah syaraf Bila ada satu saja
tepi ? Jawaban “ Ya “
 Adakah nyeri tekan pada MAKA
syaraf tepi ? Berarti reaksi berat
 Apakah kekuatan otot / rasa perlu
raba berkurang dalam 6 Diberi prednison.
bulan terakhir ?
 Adakah Lagopthalmus yang
baru terjadi dalam 6 bulan
terakhir ?
 HASIL PEMERIKSAAN P O D

Bila ada jawaban “ya” dalam kesimpulan hasil pemeriksaan POD :

• Kesimpulan pemeriksaan : REAKSI BERAT

• Berikan PREDNISON tablet sesuai prosedur.

• Evaluasi tiap 2 minggu (periksa ulang POD)

• Bila reaksi berat terjadi dalam masa pengobatan,

MDT tidak boleh dihentikan

• Bagi penderita reaksi berat setelah RFT, MDT tidak perlu diulang