Frequent neurovascular assessment is required for musculoskeletal disorders, especially from fractures due to the risk of nerve and muscle anoxia and necrosis.
Indicators of Peripheral Neurovascular Dysfunction
- Circulation:
- Color: pale, cyanotic, or mottled
- Temperature: cool
- Capillary Refill: more than 3 seconds
- Motion: weakness, paralysis
- Sensation: paresthesia, unrelenting pain, pain on passive stretching, absence of feeling
Assessing for Peripheral Nerve Function
Evaluation of sensation and evaluation of motion. The nurse may perform one or all of the following during a musculoskeletal assessment:
| Nerve | Test of Sensation | Test of Movement |
|---|---|---|
| Peroneal | Prick the skin midway between the great and second toe (second intrametatarsal space). | Ask the patient to dorsiflex the foot and extend the toes |
| Tibial | Pick the medial and lateral surface of the sole. | Ask the patient to plantar flex the toes and foot. |
| Radial | Prick the skin midway between the thumb and the second finger. | Ask the patient to stretch out the thumb, then the wrist, and then the fingers at the metacarpal joints. |
| Ulnar | Prick the distal fat pad of the small finger. | Ask the patient to abduct all fingers. |
| Median | Prick the top or distal surface of the index finger. | Ask the patient to touch the thumb to the little finger. Observe whether the patient can flex the wrist. |