ABSTRACT
Formal testing of sensation as part of the neurological examination followed the improvements
in examination techniques as well as advances in neuroscience. By the 1890s, the observation
that temperature sense was frequently impaired at the same time that pain was appreciated
led to the supposition that the two paths traveled closely. Through the works of Brown-Séquard
and Edinger the existence of a crossed afferent tract was verified. The distinction
between two sensory pathways was clear by 1898, when van Gehuchten reported a case
of syringomyelia and suggested that the pain and temperature fibers were carried anterolaterally
and the position sense fibers carried posteriorly in the spinal cord. Many authors
describing patients with tabes dorsalis suspected the posterior columns of the spinal
cord played a key role in position sense. It is difficult to determine in the 19th
century who first employed the use of movements of joints as a test for proprioceptive
function; however, Bell in 1826 recognized what he termed a sixth sense, which later was characterized as proprioceptive function. Goldscheider went on to
report the degrees of movement that were considered normal for each joint. Although
vibratory sense had been described by Cardano and Ingrassia in the 16th century and
tests had been developed by Rinne and Rumpf by the 19th century, it was not until
1903 that Rydel and Seiffer found that vibratory sense and proprioceptive sense were
closely related and that both senses were carried in the posterior columns of the
spinal cord. By 1955, the sensory examination included tests for light-touch, superficial
pain, temperature, position sense, vibration, muscle (deep pain), and two-point discrimination.
Tests for these sensibilities still remain in use. We will review the origins of the
understanding of sensation, which ultimately led to the development of the sensory
examination. We will highlight individuals who made important discoveries and observations,
as well as review the history of each of the elements of the sensory examination.
KEYWORD
History - sensory - examination - neurological - tuning fork - pinprick - proprioception
- two-point
