II. Indications
- Cerebellar Function evaluation
III. Technique
- Patient starts seated or standing
- Examiner places their index finger at various locations in front of the patient
- Finger is at a distance that requires patient to extend their elbow to reach the target
- Patient uses their index finger on one hand
- Patient touches their index finger to the examiner's finger
- Patient then touches their index finger to their own nose
- Repeat several times with the examiner moving their target finger each time
- Patient repeats the process using the opposite hand's index finger
- Additional testing: Eyes closed
- Examiner holds finger in one place while patient repeats the test above
- Patient closes their eyes and repeats the testing again
IV. Precautions: Pitfalls
- Patient should not hold their arms adducted at their sides
- Adduction allows the patient to "cheat", bracing their arm against their side
- Masks Tremor
V. Interpretation: Cerebellar dysfunction findings
- Clumsy and unsteady movements
- Finger may initially overshoot target, swinging side to side as it gets closer and finally reaches its target (measuring, dysmetria)
- Intention Tremor (Action Tremor) may also be present as the finger gets closer to its target
- Incoordination often worsens with eyes closed (suggesting position sense dysfunction)
- Consistent dysmetria to one side (past pointing)
VI. References
- Degowin (1986) Bedside Diagnostic Exam, 5th ed, MacMillan Publishing Company, p. 826
- Bates (1991) Physical Exam, Lippincott, 5th ed, p. 530-1