Physical examination maneuver

Physical Exam

Finger-to-nose

🎬
Video coming soon

How to Perform

Ask the patient to alternately touch the tip of their own nose and then your fingertip held at arm's length, repeating as you move your finger to different positions. Watch the movement for accuracy and smoothness, including any overshoot (dysmetria) or a tremor that worsens as the finger nears a target (intention tremor).

How to Interpret

Showing 3 of 8 findings

Multiple System Atrophy

Cerebellar signs
Rule in
Very helpfulDerived CI
Rule out
Minimally helpfulDerived CI
Evidence:Moderate

Stroke

Limb ataxia (dysmetria) in a patient with acute dizziness
Rule in
Very helpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:StrongResearch in progress
Ataxia (limb or gait) in a patient with confirmed acute ischemic stroke
Rule in
HelpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:Moderate

Related Bedside Tests

🎬Video coming soon
Gait Assessment
Rule in:VHStroke, HFalls, HVascular Parkinsonism +24 more
Rule out:SHDementia, SHVascular Parkinsonism, MHFalls +24 more
🎬Video coming soon
Heel-to-shin
aka Heel-knee-shin test
Rule in:IECerebellar Disease, IEMultiple Sclerosis, IESensory Ataxia
Rule out:IECerebellar Disease, IEMultiple Sclerosis, IESensory Ataxia
🎬Video coming soon
Pronator Drift
Rule in:VHBrain Tumor, VHFunctional Neurologic Disease, HUpper Motor Neuron Lesion +5 more
Rule out:VHFunctional Neurologic Disease, VHUpper Motor Neuron Lesion, MHBrain Tumor +5 more
🎬Video coming soon
Babinski Reflex
aka Plantar reflex
Rule in:VHUpper Motor Neuron Lesion, VHVascular Parkinsonism, HMultiple System Atrophy +4 more
Rule out:SHUpper Motor Neuron Lesion, MHMultiple System Atrophy, NHVascular Parkinsonism +4 more
🎬Video coming soon
Patellar Deep Tendon Reflex
aka Knee jerk
Rule in:VHLumbosacral Radiculopathy, VHPeripheral Neuropathy, IECerebellar Disease +5 more
Rule out:SHPeripheral Neuropathy, ICLumbosacral Radiculopathy, IECerebellar Disease +5 more
🎬Video coming soon
Tandem Gait
aka Heel-to-toe walking
Rule in:HAtypical Parkinsonism, SHParkinson Disease, SHVestibular Dysfunction +4 more
Rule out:HAtypical Parkinsonism, HParkinson Disease, SHVestibular Dysfunction +4 more

Related Systems / Regions

NeurologicalUpper Extremities

Related Diagnoses

Cerebellar DiseaseMultiple SclerosisMultiple System AtrophyStrokeUnilateral Cerebellar Lesion

Related Chief Complaints

Balance ProblemsBladder ProblemsBurning FeetClumsinessDifficulty WalkingDizzinessDouble VisionElectric Shock with Neck BendingEye Pain with MovementFatigueFoot NumbnessFoot PainFrequent FallsLoss of CoordinationLoss of SensationNumbnessPins and NeedlesShuffling GaitSlurred SpeechTinglingTremorTremor on One SideUnsteady GaitVision Loss in One EyeWeakness

References

Research in progress on one or more findings above; ratings may change.

  • Feys PG, Davies-Smith A, Jones R, Romberg A, Ruutiainen J, Helsen WF, Ketelaer P. Intention tremor rated according to different finger-to-nose test protocols: a survey. Arch Phys Med Rehabil. 2003;84(1):79-82. doi:10.1053/apmr.2003.50068. PMID 12589625.
  • Tao WD, Liu M, Fisher M, et al. Posterior versus anterior circulation infarction: how different are the neurological deficits? Stroke. 2012;43(8):2060-2065. doi:10.1161/STROKEAHA.112.652420. PMID: 22678088.
  • Wenning GK, Ben-Shlomo Y, Hughes A, Daniel SE, Lees A, Quinn NP. What clinical features are most useful to distinguish definite multiple system atrophy from Parkinson's disease? J Neurol Neurosurg Psychiatry. 2000;68(4):434-440. doi:10.1136/jnnp.68.4.434. PMID: 10727478; PMCID: PMC1736862.
  • Runchey S, McGee S. Does this patient have a hemorrhagic stroke? Clinical findings distinguishing hemorrhagic stroke from ischemic stroke. JAMA. 2010;303(22):2280-2286. PMID: 20530782.
  • Shah VP, Oliveira J E Silva L, Farah W, et al. Diagnostic accuracy of the physical examination in emergency department patients with acute vertigo or dizziness: a systematic review and meta-analysis for GRACE-3. Acad Emerg Med. 2023;30(5):552-578. doi:10.1111/acem.14630. PMID: 36453134.
  • Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
  • Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 10, 2026.