The sensory examination should be directed by the clinical history.

• If the patient has no sensory complaints then a screening examination can be done.
• A screening sensory exam should sample the major functional subdivisions of the sensory systems. The patient's eyes should be closed throughout the sensory examination. The stimuli should routinely be applied lightly so that minor abnormalities can be detected. Modalities from the anterolateral system (pain, temperature, and light touch), dorsal column-medial lemniscal system (vibration, proprioception, and discriminative touch), and hemispheric (stereognosis, graphesthesia) sensory functions should be screened.
  
  • Pain and vibration and light touch should be compared at distal and proximal sites on the extremities, and the right side should be compared with the left.
  • Proprioception should be tested in the fingers and toes and at larger joints only if losses are detected.
  • Stereognosis and graphesthesia should be tested in the hands if deficits in the primary modalities are minor or absent.
• Sometimes patients can have a peripheral neuropathy that is evident on exam without clinical symptoms. This should prompt you to ask about familial neuropathies and take a drug history to see if a drug could be responsible for the neuropathy.
• If someone has back pain, you should look for evidence of a radiculopathy (root compression)
• If someone has associated bowel and urinary symptoms along with numbness and weakness in the legs +/- arms, then you should look for a sensory level suggestive of a spinal cord lesion

Your job is to determine if the abnormality is due to a problem in the brain, spinal cord, root or nerve.