SLR - October 2010 - Chuck Hoehn

Does This Patient With Diabetes Have Large-Fiber Peripheral Neuropathy?

Reference: Kanji, J.N., Anglin, R.E., Hunt, D.L., Panju, A. (2010). Does This Patient With Diabetes Have Large-Fiber Peripheral Neuropathy? The Journal Of The American Medical Association, April 21, 2010 – Vol 303, No.15 1526-1532

Scientific Literature Reviews

Reviewed by: Chuck Hoehn, DPM PGY1
Residency Program: University Hospitals Richmond Medical Center/OCPM

Podiatric Relevance:
This article provides a review on the different methods of bedside clinical examination of large-fiber peripheral neuropathy (LFPN), and determines what are the best and most reliable examination techniques.

This literature review consisted of a structured search of MEDLINE (January 1966-November 2009) and EMBASE (1980-2009) to find English language articles on bedside diagnosis of diabetic peripheral neuropathy.

Out of 1388 identified articles, 9 articles were on diagnostic accuracy and 3 articles were on precision of diagnosing large-fiber peripheral neuropathy.  It was found that the most useful examination findings were vibratory perception with a 128-Hz tuning fork and pressure sensation with a 5.07 Semmes-Weinstein monofilament.  Other tests that were included were deep tendon reflexes as well as dermatological exams, which were looking for the evidence of ulcerations or pre-ulcerative lesions. 

When diagnosing a diabetic patient with LFPN, a thorough physical exam along with a detailed patient history is needed.   Abnormal results from the vibratory and monofilament testing alone or in combination help aid in the correct diagnosis of LFPN.  Those tests, combined with ulcerations or pre-ulcerative lesions help make the precision of the diagnosis that much greater.   Nerve conduction studies along with nerve biopsy and skin biopsies can provide additional valuable information as to the degree of nerve damage, as well as axonal degeneration.


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