Peripheral neuropathy physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
Testing for peripheral neuropathy may include: Gross light touch, pinprick sensation test, gait tests, a 128-Hz tuning fork placement at the base of the great toenail, semmes-Weinstein monofilament, deep tendon reflexes tests, muscle Strength Grading ( Motor testing, muscle strength grading, manual muscle testing), tinel testing (Paresthesias or pain suggests median nerve injury), cranial nerve testing, anal sphincter tone test, cardiovascular reflexes, pupillary reflexes. The 2 tests should be performed at least every year for patients with diabetic peripheral neuropathy.Patients with peripheral neuropathy usually appear normal. In vital signs examination these findings may be seen: High-grade or low-grade fever, hypothermia or hyperthermia, tachycardia with regular pulse or irregular pulse, bradycardia with regular pulse or regularly irregular pulse, tachypnea or bradypnea, high or low blood pressure with normal pulse pressure or wide pulse pressure or narrow pulse pressure. In physical examination of the skin of patients with peripheral neuropathy these finding may be present: skin dryness, calluses, bruises, skin color changes.
Physical Examination
- Testing for peripheral neuropathy may include:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]
- Gross light touch
- Pinprick sensation
- Gait tests
- Vibratory sense test:
- A 128-Hz tuning fork placed at the base of the great toenail.
- Semmes-Weinstein monofilament
- Deep tendon reflexes test:
- In patients with peripheral neuropathy, these reflexes are commonly hypoactive or absent
- Muscle Strength Grading: Muscle strength testing is an important component of the physical examination that can reveal information about neurologic deficits. It is used to evaluate weakness and can be effective in differentiating true weakness from imbalance or poor endurance. It may be referred to as:
- Motor testing
- Muscle strength grading
- Manual muscle testing
- Tinel testing: Paresthesias or pain suggests median nerve injury
- Cranial nerve testing
- Walk on the heels and toes
- Anal sphincter tone test
- Autonomic nervous system tests:
- Pupillary reflexes
- Casual sweating patterns
- The 2 tests should be performed at least every year for patients with diabetic peripheral neuropathy.
Appearance of the Patient
- Patients with peripheral neuropathy usually appear normal.
Vital Signs
Depend on the type of the neuropathy these findings may be seen:[13][1][2][3]
- High-grade or low-grade fever
- Hypothermia or hyperthermia
- Tachycardia with regular pulse or irregular pulse
- Bradycardia with regular pulse or regularly irregular pulse
- Tachypnea or bradypnea
- High or low blood pressure with normal pulse pressure or wide pulse pressure or narrow pulse pressure.
Skin
In physical examination of the skin of patients with peripheral neuropathy these finding may be present:[16]
- Skin dryness
- Tinea pedisracks
- Onychomycoses
- Calluses
- Bruises
- Skin color changes
Neck
- Neck examination of patients with peripheral neuropathy is usually normal.
Lungs
- Pulmonary examination of patients with peripheral neuropathy is usually normal.
Heart
- In physical examination of the cardiovascular system of patients with peripheral neuropathy these finding may be present:[17][18]
- Tachycardia with regular pulse or irregular pulse
- Bradycardia with regular pulse or regularly irregular pulse
- High or low blood pressure with normal pulse pressure or wide pulse pressure or narrow pulse pressure.
- Many kinds of arrhythmia
- Heart conduction system blocks
Abdomen
In physical examination of the abdomen of patients with peripheral neuropathy these finding may be present:[19]
Back
- Back examination of patients with peripheral neuropathy is usually normal.
Neuromuscular
- Testing for peripheral neuropathy may include:[5][6][7][10][11][13][14]
- Gross light touch
- Pinprick sensation
- Gait tests
- Vibratory sense test:
- A 128-Hz tuning fork placed at the base of the great toenail.
- Semmes-Weinstein monofilament
- Deep tendon reflexes test:
- In patients with peripheral neuropathy, these reflexes are commonly hypoactive or absent
- Muscle strength Grading: Muscle strength testing is an important component of the physical examination that can reveal information about neurologic deficits. It is used to evaluate weakness and can be effective in differentiating true weakness from imbalance or poor endurance. It may be referred to as:
- Motor testing
- Muscle strength grading
- Manual muscle testing
- Tinel testing: Paresthesias or pain suggests median nerve injury
- Cranial nerve testing
- Walk on the heels and toes
- Anal sphincter tone test
- Autonomic nervous system tests:
- Cardiovascular reflexes
- Pupillary reflexes
- Casual sweating patterns
References
- ↑ 1.0 1.1 Misra UK, Kalita J, Nair PP (2008). "Diagnostic approach to peripheral neuropathy". Ann Indian Acad Neurol. 11 (2): 89–97. doi:10.4103/0972-2327.41875. PMC 2771953. PMID 19893645.
- ↑ 2.0 2.1 Watson JC, Dyck PJ (2015). "Peripheral Neuropathy: A Practical Approach to Diagnosis and Symptom Management". Mayo Clin Proc. 90 (7): 940–51. doi:10.1016/j.mayocp.2015.05.004. PMID 26141332.
- ↑ 3.0 3.1 Hughes RA (2002). "Peripheral neuropathy". BMJ. 324 (7335): 466–9. PMC 1122393. PMID 11859051.
- ↑ Marchettini P, Lacerenza M, Mauri E, Marangoni C (2006). "Painful peripheral neuropathies". Curr Neuropharmacol. 4 (3): 175–81. PMC 2430688. PMID 18615140.
- ↑ 5.0 5.1 Bansal V, Kalita J, Misra UK (2006). "Diabetic neuropathy". Postgrad Med J. 82 (964): 95–100. doi:10.1136/pgmj.2005.036137. PMC 2596705. PMID 16461471.
- ↑ 6.0 6.1 Head KA (2006). "Peripheral neuropathy: pathogenic mechanisms and alternative therapies". Altern Med Rev. 11 (4): 294–329. PMID 17176168.
- ↑ 7.0 7.1 England JD, Asbury AK (2004). "Peripheral neuropathy". Lancet. 363 (9427): 2151–61. doi:10.1016/S0140-6736(04)16508-2. PMID 15220040.
- ↑ Snyder MJ, Gibbs LM, Lindsay TJ (2016). "Treating Painful Diabetic Peripheral Neuropathy: An Update". Am Fam Physician. 94 (3): 227–34. PMID 27479625.
- ↑ Beran R (2015). "Paraesthesia and peripheral neuropathy". Aust Fam Physician. 44 (3): 92–5. PMID 25770571.
- ↑ 10.0 10.1 Won JC, Park TS (2016). "Recent Advances in Diagnostic Strategies for Diabetic Peripheral Neuropathy". Endocrinol Metab (Seoul). 31 (2): 230–8. doi:10.3803/EnM.2016.31.2.230. PMC 4923406. PMID 27246283.
- ↑ 11.0 11.1 Sciascia A, Uhl T (2015). "RELIABILITY OF STRENGTH AND PERFORMANCE TESTING MEASURES AND THEIR ABILITY TO DIFFERENTIATE PERSONS WITH AND WITHOUT SHOULDER SYMPTOMS". Int J Sports Phys Ther. 10 (5): 655–66. PMC 4595919. PMID 26491616.
- ↑ Shefner JM (2017). "Strength Testing in Motor Neuron Diseases". Neurotherapeutics. 14 (1): 154–160. doi:10.1007/s13311-016-0472-0. PMC 5233619. PMID 27600518.
- ↑ 13.0 13.1 13.2 Chowdhury D, Patel N (2006). "Approach to a case of autonomic peripheral neuropathy". J Assoc Physicians India. 54: 727–32. PMID 17212023.
- ↑ 14.0 14.1 Verrotti A, Prezioso G, Scattoni R, Chiarelli F (2014). "Autonomic neuropathy in diabetes mellitus". Front Endocrinol (Lausanne). 5: 205. doi:10.3389/fendo.2014.00205. PMC 4249492. PMID 25520703.
- ↑ Wang F, Zhang J, Yu J, Liu S, Zhang R, Ma X; et al. (2017). "Diagnostic Accuracy of Monofilament Tests for Detecting Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis". J Diabetes Res. 2017: 8787261. doi:10.1155/2017/8787261. PMC 5651135. PMID 29119118.
- ↑ Ko MH, Hu ME, Hsieh YL, Lan CT, Tseng TJ (2014). "Peptidergic intraepidermal nerve fibers in the skin contribute to the neuropathic pain in paclitaxel-induced peripheral neuropathy". Neuropeptides. 48 (3): 109–17. doi:10.1016/j.npep.2014.02.001. PMID 24630273.
- ↑ Serhiyenko VA, Serhiyenko AA (2018). "Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment". World J Diabetes. 9 (1): 1–24. doi:10.4239/wjd.v9.i1.1. PMC 5763036. PMID 29359025.
- ↑ Brock C, Brock B, Pedersen AG, Drewes AM, Jessen N, Farmer AD (2016). "Assessment of the cardiovascular and gastrointestinal autonomic complications of diabetes". World J Diabetes. 7 (16): 321–32. doi:10.4239/wjd.v7.i16.321. PMC 4999648. PMID 27625746.
- ↑ Kumar SR, Kumar AA, Roy AG, Menon U (2013). "Diabetic neuropathy: rare presentation as a painful pseudoabdominal mass". J Family Med Prim Care. 2 (3): 298–9. doi:10.4103/2249-4863.120773. PMC 3902693. PMID 24479104.