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FINAL PREPARATIONS FOR RECOMPRESSION THERAPY

Physical Examination

Sensory Systems

Anterolateral system and spinal lemnisci

Reflecting the functional integrity of the anterolateral system of the spinal cord and the spinal lemnisci of the brainstem (and its communications with the thalamus and hence the cortex) are the senses of crude touch/pressure, pain, and temperature. Importantly, damage to the anterolateral system, the spinal lemniscus, or more rostral structures produces sensory deficits on the opposite side of the body. To assess anterolateral system, the clinician may determine whether the patient can differentiate sharp and dull stimuli, with sharp stimulation being applied through the pressing of the tip of a pin firmly but not dangerously against the skin. The firm squeezing of subcutaneous tissue (e.g., tendon, muscle) may be the favored technique for eliciting deep pressure, and thus further revealing functional characteristics of the anterolateral system. Finally, the ability of the patient to discriminate cold and warm stimuli (e.g., glass vials filled with cold or warm fluid) placed against varying cutaneous regions may also signal a functional anterolateral system.