Motor, cerebellar, sensory and reflex testing all do one job: they sort a deficit into upper or lower motor neuron, and the pattern tells you where the lesion lives. Sort the findings, grade a reflex 0 to 4+ with its nerve roots, and convert a patient’s numb area into a spinal root — including the one that is a surgical emergency.
Assign each finding to the pattern it belongs to. UMN = brain or spinal cord. LMN = anterior horn, nerve root or peripheral nerve.
Strike the tendon with a loose wrist, letting the hammer fall by its own weight. The limb must be relaxed and the tendon slightly stretched — position, not force, is what makes a reflex appear.
Sensory testing needs an alert patient with eyes closed, compared side to side and distal to proximal. Do not tell the patient where you are touching, and ask “does this feel the same on both sides?” — not “can you feel this?” Click where the patient reports numbness.
Romberg test
Feet together, arms at the sides, eyes open about 20 seconds, then eyes closed about 20 seconds. Stand close enough to catch the patient every single time.