I understand sequencing for sensory testing is superficial, deep, then cortical combined, according to O’Sullivan. I am wondering if there is a particular sequence for testing dermatome for efficiency? I think varying is best for dermatome but wanted your feedback. Here is another question – how about myotomes order sequence? Start from bottom up or top down? Thank you!

Rather than varying, a systematic approach is recommended. The International Standards examination for neurological classification (sensory and motor) is used to determine the sensory/motor/neurological levels. It is also used in generating scores to characterize sensory/motor functioning and in determining completeness of injury. For both dermatomal and myotomal testing, it is recommended that the examination should be performed in rostral to caudal sequence with the patient in supine position (except for the rectal examination that can be performed side-lying).

The sensory examination is completed through the testing of a key point in each of the 28 dermatomes (from C2 to S4-5) on the right and left sides of the body that can be readily located in relation to bony anatomical landmarks. At each of these key points, two aspects of sensation are examined: light touch and pin prick (sharp-dull discrimination).

The motor examination is completed through the testing of key muscle functions corresponding to 10 paired myotomes (C5-T1 and L2-S1). It is recommended that each key muscle function should be examined in a rostral-caudal sequence, utilizing standard supine positioning and stabilization of the individual muscles being tested. Improper positioning and stabilization can lead to substitution by other muscles and will not accurately reflect the muscle function being graded.

I recommend this article for more on nuerological testing.

Reference 1