This test is used to evaluate for cerebellar disease, vestibular disease, and position sense.
Performing the Test
Worsening performance with eyes closed suggests loss of position sense
Have patient touch their index finger to their nose and then to your index finger while you move your finger so that they have to alter direction and fully extend their arm
Dysmetria: initially overshoots then reaches mark
Move your finger out at patient’s shoulder level so they fully extend their arm with their finger touching yours. Have them raise their arm overhead and back down to touch your finger and repeat. Then have them repeat with their eyes closed.
Past-pointing: misses mark consistently to one side, worse with eyes closed
Ask patient to place their heel on the opposite knee and then move it up and down the shin as if they were drawing a straight line
Positive: lack of coordination during these movements
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking. 8th ed. Philadelphia, PA: Lippincott Williams & Wilkins: 2003.