Sense Of Passive Movement

Ask the patient to watch you. If the patient does not receive a proper demonstration and instructions before you start this test, the response may be wrong half the time. Passive movement is tested at one joint only, starting at the most distal toe or finger. Hold the proximal phalanx of the patient's big toe in your left hand and anchor it. Grasp the sides of the distal phalanx of the big toe between your right thumb and index finger. Move the distal phalanx of the toe slowly up (dorsiflexion) a random number of times, telling the patient that each of these movement is "up." Do the same thing while moving the toe down. Then, with his vision shielded, make random up-and-down movements (eg, three up, two down, one up, four down), asking him to tell you each time where it is. A wrong answer for the first move in a new direction is normal. Move the distal phalanx slowly, consistently, and a small distance each time.

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