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Reviewing the evidence base for the peripheral sensory examination
1Division of Medicine, John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia.
International Journal of Clinical Practice
|February 20, 2014
Summary
This study simplifies peripheral sensory examination by differentiating large fibre sensory neuropathy (LFSN) affecting vibration and proprioception, from small fibre sensory neuropathy (SFSN) affecting pain and temperature. It guides clinicians on effective diagnostic maneuvers for both conditions.
Area of Science:
- Neurology
- Clinical Examination
- Sensory Neuroscience
Background:
- Peripheral sensory examination is a complex topic for many students.
- A need exists for evidence-based guidance on effective examination techniques.
- This review aims to clarify the most useful maneuvers for assessing peripheral sensation.
Purpose of the Study:
- To summarize evidence for peripheral sensory examination.
- To provide guidance on the most useful maneuvers for diagnosing neuropathy.
- To differentiate between large fibre and small fibre sensory neuropathies.
Main Methods:
- Literature review initiated with 5 secondary sources.
- Supplemented by a comprehensive MEDLINE literature search.
- Systematic evaluation of diagnostic approaches for sensory neuropathies.
Main Results:
- Neuropathy classification: Large Fibre Sensory Neuropathy (LFSN) affects vibration/proprioception; Small Fibre Sensory Neuropathy (SFSN) affects pain/temperature.
- SFSN suggested by positive symptoms (burning, electric pain); LFSN suggested by negative symptoms (numbness, loss of sensation).
- For LFSN, 10g monofilament testing and vibration sense are useful; for SFSN, quantitative sensory testing is most appropriate. Nerve conduction studies are indicated for LFSN.
Conclusions:
- Limited evidence currently guides peripheral sensory examination.
- Further research is necessary to enhance diagnostic capabilities.
- A structured approach aids in distinguishing LFSN and SFSN.
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