Clinical exam · Nervous system
Cerebellar tests: finger–nose, heel–shin and rapid alternating movements !
- Maneuver
Simple aiming and rhythm tasks that show whether the cerebellum is coordinating movement well.
Updated 2026-11-01
See it in 3D: Cerebellum · Vermis · Cerebellar peduncles
What it is
The cerebellum fine-tunes the direction, force and rhythm of each movement. The finger–nose, heel–shin and rapid alternating movement tests bring out dysmetria (missing the target), intention tremor and dysdiadochokinesia. Because each cerebellar hemisphere coordinates the same side of the body, clumsiness appears on the side of the lesion.
The anatomy it tests
- Lateral cerebellar hemispheres: coordinate fine limb movements on the same side.
- Vermis: controls the trunk, posture and gait.
- Flocculonodular lobe: balance and eye movements.
- The cerebellar peduncles connect the cerebellum with the brainstem, spinal cord and cortex.
How to do it
- Finger–nose: the examiner holds a finger at the reach of the patient's outstretched arm.
- Ask the patient to touch their nose and then the examiner's finger several times; the examiner moves the finger to new positions.
- Watch accuracy, smoothness and whether a tremor appears near the target.
- Heel–shin: lying down, the patient places one heel on the opposite knee and slides it down the shin to the ankle and back.
- Alternating movements: pat the back and the palm of one hand on the other hand or the thigh as fast as possible.
- Finger tapping: tap the thumb with the index finger quickly; compare each side.
- Finish with tandem gait and look for nystagmus and scanning speech.
What a positive result means
- One-sided dysmetria and intention tremor: a lesion of the cerebellar hemisphere on the same side (stroke, tumour, multiple sclerosis).
- Gait ataxia with nearly normal limb tests: a vermis lesion, such as alcohol-related degeneration.
- Acute ataxia with confusion and abnormal eye movements: Wernicke encephalopathy.
- Bilateral cerebellar ataxia: toxins or drugs, hereditary disorders, paraneoplastic causes.
Usefulness and limits
- Sensitive but not very specific: weakness, proprioceptive loss or essential tremor alter the result.
- Testing too slowly hides dysdiadochokinesia.
- MRI shows a posterior fossa lesion better than CT.
Test yourself
Think of the answer, then tap the question to see it.
On which side do the signs of a cerebellar hemisphere lesion appear?
On the same side as the lesion (ipsilateral).
What is dysdiadochokinesia?
Difficulty performing rapid alternating movements, which become slow, irregular and clumsy; it is a cerebellar sign.
Which part of the cerebellum is typically affected in alcohol-related degeneration?
The anterior vermis, so gait and trunk ataxia predominate.
See it in 3D
The structures of Durgical's 3D anatomy where it is found.
Related
- Cerebellar syndrome
- Romberg test
- Abnormal gaits: hemiparetic, parkinsonian, ataxic, steppage, waddling
- The neurological examination: order and screening exam
Related conditions
Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.
Sources: How To Assess Gait, Stance, and Coordination (MSD Manual Professional Edition, 2024); 16.5 The Coordination and Gait Exams (OpenStax, Anatomy and Physiology 2e, 2022); Cerebellar Disorders (MSD Manual Professional Edition, 2024).
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Representative model, for educational purposes only.