Circulatory Motor Sensory Testing (CMS)

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Circulatory Motor Sensory (CMS) testing of the extremities should be routinely performed:

  • Early in the physical exam of a patient whenever there is a high index of suspicion that there may be circulatory or neurological impairment to a limb
  • As part of a secondary assessment for both medical and trauma calls.
  • Before and after any intervention involving the limbs such as splinting to assess what changes the intervention has produced.

Circulatory[edit | edit source]

  1. Hands - Feel for radial pulses and check capillary refill at the nail beds.
  2. Feet - REMOVE THE SHOES AND SOCKS. Feel for dorsal pedal pulses and check capillary refill the toenail beds.

Note any weakness or asymmetry in pulses between the two opposite limbs, or any sluggish refill

Motor[edit | edit source]

  1. Grip the wrist (hands) or the ankles (feet) and ask for the patient to wiggle their fingers or toes. It is important to stabilize the joint in trauma situations because the patients can cause themselves pain by trying to move the affected joint.
  2. In the case of suspected stroke, ask the patient to grip your hands with both of their hands.

Note any asymmetries in mobility or grip strength

Sensory[edit | edit source]

  1. Out of the patient's view, touch one of the digits on the hands or feet and ask them to identify which one is being touched and if it feels normal


This rapid, easily repeatable exam will bring to light a wide variety of potential problems in the central and peripheral nervous system as well as cardiovascular issues. It should always be part of your periodic rapid recheck of a patient during transport.