Sensitivity of joint position sense test, tuning fork test, Semmes-Weinstein Monofilament Examination and Michigan Neuropathy Screening Instrument in the diagnosis of diabetic polyneuropathy

Authors

DOI:

https://doi.org/10.11606/issn.1679-9836.v100i3p246-253

Keywords:

Proprioception, Diabetic neuropathy, Diagnosis, Foot ulcer, Diabetic foot, Toe joint, Position sense

Abstract

Objectives: To compare, in patients with diabetic neuropathy, the prevalence of hallux position perception (joint position sense) test (JPST) abnormalities with tuning fork test (TFT) and Semmes-Weinstein monofilament examination (SWME) abnormalities and with the results of the questionnaire designed for neuropathic symptoms assessment that is part of the Michigan Neuropathy Screening Instrument (QMNSI). Subjects and Methods: This is a retrospective study of 35 ambulatory patients with peripheral diabetic polyneuropathy confirmed by nerve conduction studies. All the patients underwent TFT, SWME, QMNSI and JPST. Severe neuropathy was defined as peripheral neuropathy with no response to the electrical stimulation by any of the motor or sensitive nerves. Results: The prevalence of TFT (63%) and of QMNSI abnormalities (69%) in patients with diabetic neuropathy was significantly greater than JPST abnormalities (25.7%). Prevalence of abnormal JPST and TFT was increased in patients with severe nerve conduction study abnormalities. Concurrent evaluation with TFT, SWME and QMNSI was the most sensitive strategy to diabetic neuropathy diagnosis (sensitivity, 89%). SWME had a particularly low sensitivity (40%). Abnormalities revealed by JPST was significantly more prevalent in patients reporting previous ulcerations (p=0.006). However, JPST did not identify a greater number of patients with prior ulcerations when compared to the other tests. Conclusions: The application of a single test (especially JPST and SWME) in the screening of diabetic neuropathy may lead to a considerably lower sensitivity when compared to the combined use of multiple tests. JPST abnormalities have the potential to indicate a more severe neuropathy and a higher risk of ulcerations.

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Author Biographies

  • Fernando Moreno Sebastianes, Anhembi Morumbi University

    MD, PhD. Universidade de São Paulo, Faculdade de Medicina, Divisão de Endocrinologia, São Paulo, SP. Universidade Anhembi Morumbi, Piracicaba, SP.

  • Patrícia Helena Zanoni, Universidade de São Paulo, Faculdade de Medicina, Divisão de Endocrinologia

    MD. Universidade de São Paulo, Faculdade de Medicina, Divisão de Endocrinologia, São Paulo, SP.  

  • Alina Coutinho Rodrigues Feitosa, Universidade de São Paulo, Faculdade de Medicina, Divisão de Endocrinologia

    MD, PhD. Universidade de São Paulo, Faculdade de Medicina, Divisão de Endocrinologia, São Paulo, SP. Escola Médica Bahiana, Salvador, BA. 

  • Márcia Nery, Universidade de São Paulo, Faculdade de Medicina, Divisão de Endocrinologia

    MD, PhD. Universidade de São Paulo, Faculdade de Medicina, Divisão de Endocrinologia, São Paulo, SP. 

  • Maria Cândida Parisi, Universidade de São Paulo, Faculdade de Medicina, Divisão de Endocrinologia

    MD, PhD. Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP. Universidade de São Paulo, Faculdade de Medicina, Divisão de Endocrinologia, São Paulo, SP. ORCID: 

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Published

2021-07-30

Issue

Vol. 100 No. 3 (2021)

Section

Artigos/Articles

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Copyright (c) 2021 Fernando Moreno Sebastianes, Patrícia Helena Zanoni, Alina Coutinho Rodrigues Feitosa, Márcia Nery, Maria Cândida Parisi

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How to Cite

Sebastianes, F. M., Zanoni, P. H. ., Feitosa, A. C. R. ., Nery, M. ., & Parisi, M. C. . (2021). Sensitivity of joint position sense test, tuning fork test, Semmes-Weinstein Monofilament Examination and Michigan Neuropathy Screening Instrument in the diagnosis of diabetic polyneuropathy. Revista De Medicina, 100(3), 246-253. https://doi.org/10.11606/issn.1679-9836.v100i3p246-253