Reviewing the evidence base for the peripheral sensory examination

Many students find the peripheral sensory examination confusing. We set out to summarise the evidence base in order to provide guidance on the most useful manoeuvres.

We performed a literature review starting with 5 secondary sources, supplemented by a literature search on MEDLINE.

A useful approach to neuropathy is to divide these into large fibre sensory neuropathy (LFSN) in which vibration and proprioception are affected, and small fibre sensory neuropathy (SFSN) in which pain and temperature are affected. Positive sensory symptoms such as burning, electric or sunburn pain point to a SFSN; negative symptoms such as loss of sensation, numbness or deep pain point to a LFSN. If LFSN is suspected, the most reproducible and best studied physical examination is a 10 g monofilament, but vibration sense is also useful. There is much less data on the best physical examination for a SFSN. The most appropriate diagnostic test for SFSN is quantitative sensory testing, whereas for LFSN a nerve conduction study is indicated.

A modest amount of evidence is available to guide peripheral sensory examination but more research is needed.