The palpation component of the exam is performed the last to avoid losing the cooperation of the patient. We will accomplish three evaluations:

1. Spinal Palpation:

Back and neck palpation assessing for areas of spinal pain (hyperesthesia). The first time a gentle pressure should be that will be progressively increased in a second and third attempt. Starting at the interscapular area and moving caudally until the lumbosacral area is reached and further assessed by flexing dorsally, ventrally and laterally the tail. This will be followed by neck pain evaluation: from around both C6 transverse processes and moving cranially up until the atlas; we will look for tension of the cervical muscles and/or twitching. After that, the neck can be manipulated in dorsal, lateral and ventral flexion for further pain detection and reduced range of motion (avoid this when atlantoaxial instability is suspected, particularly in toy breeds of dogs).

2. Palpation of the limbs: 

Investigating for pain, atrophy, or swelling. Particularly indicated to evaluate for orthopedic conditions that could mimic a neurological disorder (as polyarthritis) and to detect focal muscle atrophy.

3. Deep pain perception:

Applying a progressively increased pressure to the bones of the digits of each limb with a hemostat. Only a behavioral response to this stimulus (vocalization, turning the head, trying to bite) indicates conscious perception of pain; flexion of the limb only indicates integrity of flexor reflex. This evaluation is a very important prognostic indication in case of spinal cord disease.