Two Point Discrimination – Physical Exam

Two point discrimination is the ability to discern that two nearby objects touching the skin are truly two distinct points, not one. It is often tested with two sharp points during a neurological examination and is assumed to reflect how finely innervated an area of skin is. In clinical settings, two-point discrimination is a widely used technique for determining tactile agnosia. It relies on the ability and/or willingness of the patient to subjectively report what they are feeling and should be completed with the patient’s eyes closed. The therapist may use calipers or simply a reshaped paperclip to do the testing. The therapist may alternate randomly between touching the patient with one point or with two points on the area being tested (e.g. finger, arm, leg, toe). The patient is asked to report whether one or two points was felt. The smallest distance between two points that still results in the perception of two distinct stimuli is recorded as the patient’s two-point threshold. Performance on the two extremities can be compared for discrepancies.