Finger-Nose-Finger Test

Aka: Finger-Nose-Finger Test, Finger-Nose-Finger, Finger-Nose Ataxia, Finger-To-Finger Test, Point-To-Point Test

1. Indications
   1. Cerebellar Function evaluation
2. Technique
   1. Patient starts seated or standing
      1. Arms abducted at Shoulder to 90 degrees
      2. Elbows flexed to 90 degrees
   2. Examiner places their index finger at various locations in front of the patient
      1. Finger is at a distance that requires patient to extend their elbow to reach the target
   3. Patient uses their index finger on one hand
      1. Patient touches their index finger to the examiner's finger
      2. Patient then touches their index finger to their own nose
      3. Repeat several times with the examiner moving their target finger each time
   4. Patient repeats the process using the opposite hand's index finger
   5. Additional testing: Eyes closed
      1. Examiner holds finger in one place while patient repeats the test above
      2. Patient closes their eyes and repeats the testing again
3. Precautions: Pitfalls
   1. Patient should not hold their arms adducted at their sides
      1. Adduction allows the patient to "cheat", bracing their arm against their side
      2. Masks Tremor
4. Interpretation: Cerebellar dysfunction findings
   1. Clumsy and unsteady movements
   2. Finger may initially overshoot target, swinging side to side as it gets closer and finally reaches its target (measuring, dysmetria)
   3. Intention Tremor (Action Tremor) may also be present as the finger gets closer to its target
   4. Incoordination often worsens with eyes closed (suggesting position sense dysfunction)
   5. Consistent dysmetria to one side (past pointing)
5. References
   1. Degowin (1986) Bedside Diagnostic Exam, 5th ed, MacMillan Publishing Company, p. 826
   2. Bates (1991) Physical Exam, Lippincott, 5th ed, p. 530-1