Tests Used to Assess Proprioception
The primary tests used to assess proprioception include joint position sense testing, vibration sensation testing, the Romberg test, finger-to-nose test, heel-to-shin test, and specialized tests like the thumb and big-toe localizing tests.
Basic Proprioception Assessment Tests
- Joint Position Sense Testing: The examiner moves a joint (typically the great toe or finger) up or down and asks the patient to identify the direction with eyes closed 1, 2
- Vibration Sensation Testing: Using a 128-Hz tuning fork placed on bony prominences to assess vibration perception 1
- Romberg Test: Patient stands with feet together and eyes closed to assess balance with proprioceptive input only 1
- 10-g Monofilament Test: Used to assess protective sensation, often in conjunction with proprioception testing 1
Specialized Coordination Tests
- Finger-to-Nose Test: Patient touches their nose with index finger and then touches examiner's finger; assesses upper limb coordination and proprioception 2
- Heel-to-Shin Test: Patient slides heel down opposite shin; evaluates lower limb proprioception 2
- Pinprick Test: Assesses pain sensation which can be affected alongside proprioception 1
Advanced Proprioception Tests
- Thumb Localizing Test (TLT): Examiner positions one of the patient's upper limbs with eyes closed, and patient must pinch the thumb of that limb with the opposite thumb and index finger 3, 4
- Big-Toe Localizing Test (BLT): Similar to TLT but for lower limbs; patient must locate their passively positioned big toe with their index finger 4, 5
- Joint Position Sense Error Measurement: Quantitative assessment of proprioceptive accuracy, measuring the degree of error in reproducing joint positions 6
Comprehensive Assessment Approach
- Clinical proprioception assessment should include both low-level judgments (detection, discrimination, matching) and high-level proprioceptive abilities (spatial awareness of limb position) 7
- Proprioception testing should be performed at multiple joints, as deficits may vary by location 1
- Annual comprehensive foot examination should include proprioception testing in patients with diabetes, particularly after 5 years of disease duration 1
Clinical Considerations
- Proprioceptive deficits often correlate with other deep or discriminative sensory deficits but may be dissociated from pain and temperature sensation 3
- Patients with cognitive impairment may have difficulty following instructions for proprioceptive testing 2
- Specialized tests like TLT and BLT are more sensitive than standard joint position sense tests for detecting lesions in the posterior column-medial lemniscal system 4, 5
- Proprioception assessment should be considered in patients with peripheral neuropathy even without pain symptoms 8