Circulatory Motor Sensory Testing (CMS)

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.

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.

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 and/or posterior tibial 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.
3. Note any asymmetries in mobility or grip strength

Motor testing of the upper extremity can be performed in a variety of different manners. Commonly, "wiggle your fingers/toes" is used because it is difficult to misinterpret and the fingers/toes are the most distal part of the hand/foot.

Here are some other examples:

Upper Extremity[edit | edit source]

• "Squeeze my hands"
• "Touch your pinky/ring/middle/pointer finger to your thumb"
• "Lift your arms and bend your elbows"
• "Show me rock, paper, and scissors"
• "Show me 'Jazz hands'"
• "Give me an 'OK' symbol"

Lower Extremity[edit | edit source]

• "Push down on my hand like a gas pedal with your feet"
• "Stop me from pulling your foot down"
• "Rub your shin with the heel on your opposite foot"
• "Rotate your foot"
• "Lift your leg up parallel from the bed"
• "Bend your knee"

Sensory[edit | edit source]

The most commonly used sensory test is asking the patient to close their eyes while pressing on a finger/toe and asking them which finger/toe is being touched.

Additional sensory tests include:

• Asking the patient to discern between sharp and dull sensation
• Asking the patient if they have any numbness/tingling
• If the patient reports numbness/tingling, assessing to see if the numbness/tingling impedes normal sensation
• Testing for a positive Babinski Reflex
• Testing for temperature sensation (rarely done prehospitally, but significant in potential anterior cord, central cord, or Brown-Sequard syndromes*)

*Posterior cord syndrome is also possible but rarely seen in EMS compared to the others as it is not common in trauma.

Self Assessment[edit | edit source]