Care should be taken that equal pressure be made on all points palpated on one nerve. If the nerve pass over a bone, less force is needed to exert the same pressure than if it overlie muscle or other soft structure. The force used varies constantly as the hand moves from place to place, according to the density and hardness of the structures overlying and underlying a nerve.
Sufficiently heavy pressure will elicit tenderness in all except anaesthetic patients. But if a nerve be irritated it will be tender without heavy pressure, when the finger really makes a close contact with it.
If the patient willfully attempts to deceive the palpater, nerve-tracing might as well be abandoned except in those extreme cases where the patient will flinch against his will on account of extreme sensitiveness.
Use of Second Hand
As far as possible, the second hand is placed opposite the tracing hand and steadily supports the body; its position changes with changes in the position of the first. If the arm is to be examined it had best be held away from the body, and the part to be examined held between the two hands.
Position of Patient
For tracing nerves in the neck, back, and upper extremities, the patient should sit easily. For lumbar, abdominal, or pelvic tracing, or for tracing in the lower extremities, have patient lie on side or back. Do not hesitate to change the position of the patient as often as is necessary to secure easy access to the part to be examined and relaxation of the patient’s muscles. Never allow the assumption of a strained position during tracing; the sensation of cramped muscles may be confused with sensations of nerve tenderness.