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==Overview==
==Overview==
Diagnosing peripheral neuropathy is often difficult because the symptoms are highly variable. A thorough neurological examination is usually required and involves taking an extensive patient history (including the patient’s symptoms, work environment, social habits, exposure to any toxins, history of alcoholism, risk of HIV or other infectious disease, and family history of neurological disease), performing tests that may identify the cause of the neuropathic disorder, and conducting tests to determine the extent and type of nerve damage.
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, [[Monofilament|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 reflex|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 CT|tachypnea]] or [[Bradypnea|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==
==Physical Examination==
A general physical examination and related tests may reveal the presence of a systemic disease causing nerve damage. Blood tests can detect diabetes, vitamin deficiencies, liver or kidney dysfunction, other metabolic disorders, and signs of abnormal immune system activity. An examination of cerebrospinal fluid that surrounds the brain and spinal cord can reveal abnormal antibodies associated with neuropathy. More specialized tests may reveal other blood or cardiovascular diseases, connective tissue disorders, or malignancies. Tests of muscle strength, as well as evidence of cramps or fasciculations, indicate motor fiber involvement. Evaluation of a patient’s ability to register vibration, light touch, body position, temperature, and pain reveals sensory nerve damage and may indicate whether small or large sensory nerve fibers are affected.


Based on the results of the neurological exam, physical exam, patient history, and any previous screening or testing, additional testing may be ordered to help determine the nature and extent of the neuropathy.
*Testing for peripheral neuropathy may include:<ref name="pmid19893645">{{cite journal| author=Misra UK, Kalita J, Nair PP| title=Diagnostic approach to peripheral neuropathy. | journal=Ann Indian Acad Neurol | year= 2008 | volume= 11 | issue= 2 | pages= 89-97 | pmid=19893645 | doi=10.4103/0972-2327.41875 | pmc=2771953 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19893645  }} </ref><ref name="pmid26141332">{{cite journal| author=Watson JC, Dyck PJ| title=Peripheral Neuropathy: A Practical Approach to Diagnosis and Symptom Management. | journal=Mayo Clin Proc | year= 2015 | volume= 90 | issue= 7 | pages= 940-51 | pmid=26141332 | doi=10.1016/j.mayocp.2015.05.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26141332  }} </ref><ref name="pmid11859051">{{cite journal| author=Hughes RA| title=Peripheral neuropathy. | journal=BMJ | year= 2002 | volume= 324 | issue= 7335 | pages= 466-9 | pmid=11859051 | doi= | pmc=1122393 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11859051  }} </ref><ref name="pmid18615140">{{cite journal| author=Marchettini P, Lacerenza M, Mauri E, Marangoni C| title=Painful peripheral neuropathies. | journal=Curr Neuropharmacol | year= 2006 | volume= 4 | issue= 3 | pages= 175-81 | pmid=18615140 | doi= | pmc=2430688 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18615140  }} </ref><ref name="pmid16461471">{{cite journal| author=Bansal V, Kalita J, Misra UK| title=Diabetic neuropathy. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 964 | pages= 95-100 | pmid=16461471 | doi=10.1136/pgmj.2005.036137 | pmc=2596705 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16461471  }} </ref><ref name="pmid17176168">{{cite journal| author=Head KA| title=Peripheral neuropathy: pathogenic mechanisms and alternative therapies. | journal=Altern Med Rev | year= 2006 | volume= 11 | issue= 4 | pages= 294-329 | pmid=17176168 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17176168  }} </ref><ref name="pmid15220040">{{cite journal| author=England JD, Asbury AK| title=Peripheral neuropathy. | journal=Lancet | year= 2004 | volume= 363 | issue= 9427 | pages= 2151-61 | pmid=15220040 | doi=10.1016/S0140-6736(04)16508-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15220040  }} </ref><ref name="pmid27479625">{{cite journal| author=Snyder MJ, Gibbs LM, Lindsay TJ| title=Treating Painful Diabetic Peripheral Neuropathy: An Update. | journal=Am Fam Physician | year= 2016 | volume= 94 | issue= 3 | pages= 227-34 | pmid=27479625 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27479625  }} </ref><ref name="pmid25770571">{{cite journal| author=Beran R| title=Paraesthesia and peripheral neuropathy. | journal=Aust Fam Physician | year= 2015 | volume= 44 | issue= 3 | pages= 92-5 | pmid=25770571 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25770571  }} </ref><ref name="pmid27246283">{{cite journal| author=Won JC, Park TS| title=Recent Advances in Diagnostic Strategies for Diabetic Peripheral Neuropathy. | journal=Endocrinol Metab (Seoul) | year= 2016 | volume= 31 | issue= 2 | pages= 230-8 | pmid=27246283 | doi=10.3803/EnM.2016.31.2.230 | pmc=4923406 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27246283  }} </ref><ref name="pmid26491616">{{cite journal| author=Sciascia A, Uhl T| title=RELIABILITY OF STRENGTH AND PERFORMANCE TESTING MEASURES AND THEIR ABILITY TO DIFFERENTIATE PERSONS WITH AND WITHOUT SHOULDER SYMPTOMS. | journal=Int J Sports Phys Ther | year= 2015 | volume= 10 | issue= 5 | pages= 655-66 | pmid=26491616 | doi= | pmc=4595919 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26491616  }} </ref><ref name="pmid27600518">{{cite journal| author=Shefner JM| title=Strength Testing in Motor Neuron Diseases. | journal=Neurotherapeutics | year= 2017 | volume= 14 | issue= 1 | pages= 154-160 | pmid=27600518 | doi=10.1007/s13311-016-0472-0 | pmc=5233619 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27600518  }} </ref><ref name="pmid17212023">{{cite journal| author=Chowdhury D, Patel N| title=Approach to a case of autonomic peripheral neuropathy. | journal=J Assoc Physicians India | year= 2006 | volume= 54 | issue=  | pages= 727-32 | pmid=17212023 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17212023  }} </ref><ref name="pmid25520703">{{cite journal| author=Verrotti A, Prezioso G, Scattoni R, Chiarelli F| title=Autonomic neuropathy in diabetes mellitus. | journal=Front Endocrinol (Lausanne) | year= 2014 | volume= 5 | issue=  | pages= 205 | pmid=25520703 | doi=10.3389/fendo.2014.00205 | pmc=4249492 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25520703  }} </ref><ref name="pmid29119118">{{cite journal| author=Wang F, Zhang J, Yu J, Liu S, Zhang R, Ma X et al.| title=Diagnostic Accuracy of Monofilament Tests for Detecting Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis. | journal=J Diabetes Res | year= 2017 | volume= 2017 | issue=  | pages= 8787261 | pmid=29119118 | doi=10.1155/2017/8787261 | pmc=5651135 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29119118  }} </ref>
**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 reflex]]es
**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:<ref name="pmid17212023">{{cite journal| author=Chowdhury D, Patel N| title=Approach to a case of autonomic peripheral neuropathy. | journal=J Assoc Physicians India | year= 2006 | volume= 54 | issue=  | pages= 727-32 | pmid=17212023 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17212023  }} </ref><ref name="pmid19893645">{{cite journal| author=Misra UK, Kalita J, Nair PP| title=Diagnostic approach to peripheral neuropathy. | journal=Ann Indian Acad Neurol | year= 2008 | volume= 11 | issue= 2 | pages= 89-97 | pmid=19893645 | doi=10.4103/0972-2327.41875 | pmc=2771953 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19893645  }} </ref><ref name="pmid26141332">{{cite journal| author=Watson JC, Dyck PJ| title=Peripheral Neuropathy: A Practical Approach to Diagnosis and Symptom Management. | journal=Mayo Clin Proc | year= 2015 | volume= 90 | issue= 7 | pages= 940-51 | pmid=26141332 | doi=10.1016/j.mayocp.2015.05.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26141332  }} </ref><ref name="pmid11859051">{{cite journal| author=Hughes RA| title=Peripheral neuropathy. | journal=BMJ | year= 2002 | volume= 324 | issue= 7335 | pages= 466-9 | pmid=11859051 | doi= | pmc=1122393 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11859051  }} </ref>
 
*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:<ref name="pmid24630273">{{cite journal| author=Ko MH, Hu ME, Hsieh YL, Lan CT, Tseng TJ| title=Peptidergic intraepidermal nerve fibers in the skin contribute to the neuropathic pain in paclitaxel-induced peripheral neuropathy. | journal=Neuropeptides | year= 2014 | volume= 48 | issue= 3 | pages= 109-17 | pmid=24630273 | doi=10.1016/j.npep.2014.02.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24630273  }} </ref>
*[[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:<ref name="pmid29359025">{{cite journal| author=Serhiyenko VA, Serhiyenko AA| title=Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment. | journal=World J Diabetes | year= 2018 | volume= 9 | issue= 1 | pages= 1-24 | pmid=29359025 | doi=10.4239/wjd.v9.i1.1 | pmc=5763036 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29359025  }} </ref><ref name="pmid27625746">{{cite journal| author=Brock C, Brock B, Pedersen AG, Drewes AM, Jessen N, Farmer AD| title=Assessment of the cardiovascular and gastrointestinal autonomic complications of diabetes. | journal=World J Diabetes | year= 2016 | volume= 7 | issue= 16 | pages= 321-32 | pmid=27625746 | doi=10.4239/wjd.v7.i16.321 | pmc=4999648 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27625746  }} </ref>
*[[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:<ref name="pmid24479104">{{cite journal| author=Kumar SR, Kumar AA, Roy AG, Menon U| title=Diabetic neuropathy: rare presentation as a painful pseudoabdominal mass. | journal=J Family Med Prim Care | year= 2013 | volume= 2 | issue= 3 | pages= 298-9 | pmid=24479104 | doi=10.4103/2249-4863.120773 | pmc=3902693 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24479104  }} </ref>
*[[Abdominal distention]]
*[[Abdominal tenderness]]
 
===Back===
* [[Back]] examination of patients with peripheral neuropathy is usually normal.
 
===Neuromuscular===
*Testing for peripheral neuropathy may include:<ref name="pmid16461471">{{cite journal| author=Bansal V, Kalita J, Misra UK| title=Diabetic neuropathy. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 964 | pages= 95-100 | pmid=16461471 | doi=10.1136/pgmj.2005.036137 | pmc=2596705 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16461471  }} </ref><ref name="pmid17176168">{{cite journal| author=Head KA| title=Peripheral neuropathy: pathogenic mechanisms and alternative therapies. | journal=Altern Med Rev | year= 2006 | volume= 11 | issue= 4 | pages= 294-329 | pmid=17176168 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17176168  }} </ref><ref name="pmid15220040">{{cite journal| author=England JD, Asbury AK| title=Peripheral neuropathy. | journal=Lancet | year= 2004 | volume= 363 | issue= 9427 | pages= 2151-61 | pmid=15220040 | doi=10.1016/S0140-6736(04)16508-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15220040  }} </ref><ref name="pmid27246283">{{cite journal| author=Won JC, Park TS| title=Recent Advances in Diagnostic Strategies for Diabetic Peripheral Neuropathy. | journal=Endocrinol Metab (Seoul) | year= 2016 | volume= 31 | issue= 2 | pages= 230-8 | pmid=27246283 | doi=10.3803/EnM.2016.31.2.230 | pmc=4923406 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27246283  }} </ref><ref name="pmid26491616">{{cite journal| author=Sciascia A, Uhl T| title=RELIABILITY OF STRENGTH AND PERFORMANCE TESTING MEASURES AND THEIR ABILITY TO DIFFERENTIATE PERSONS WITH AND WITHOUT SHOULDER SYMPTOMS. | journal=Int J Sports Phys Ther | year= 2015 | volume= 10 | issue= 5 | pages= 655-66 | pmid=26491616 | doi= | pmc=4595919 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26491616  }} </ref><ref name="pmid17212023">{{cite journal| author=Chowdhury D, Patel N| title=Approach to a case of autonomic peripheral neuropathy. | journal=J Assoc Physicians India | year= 2006 | volume= 54 | issue=  | pages= 727-32 | pmid=17212023 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17212023  }} </ref><ref name="pmid25520703">{{cite journal| author=Verrotti A, Prezioso G, Scattoni R, Chiarelli F| title=Autonomic neuropathy in diabetes mellitus. | journal=Front Endocrinol (Lausanne) | year= 2014 | volume= 5 | issue=  | pages= 205 | pmid=25520703 | doi=10.3389/fendo.2014.00205 | pmc=4249492 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25520703  }} </ref>
**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==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 17:39, 28 August 2018

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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

  • 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]

Skin

In physical examination of the skin of patients with peripheral neuropathy these finding may be present:[16]

Neck

  • Neck examination of patients with peripheral neuropathy is usually normal.

Lungs

  • Pulmonary examination of patients with peripheral neuropathy is usually normal.

Heart

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


References

  1. ↑ 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. ↑ 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. ↑ 3.0 3.1 Hughes RA (2002). "Peripheral neuropathy". BMJ. 324 (7335): 466–9. PMC 1122393. PMID 11859051.
  4. ↑ Marchettini P, Lacerenza M, Mauri E, Marangoni C (2006). "Painful peripheral neuropathies". Curr Neuropharmacol. 4 (3): 175–81. PMC 2430688. PMID 18615140.
  5. ↑ 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. ↑ 6.0 6.1 Head KA (2006). "Peripheral neuropathy: pathogenic mechanisms and alternative therapies". Altern Med Rev. 11 (4): 294–329. PMID 17176168.
  7. ↑ 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.
  8. ↑ Snyder MJ, Gibbs LM, Lindsay TJ (2016). "Treating Painful Diabetic Peripheral Neuropathy: An Update". Am Fam Physician. 94 (3): 227–34. PMID 27479625.
  9. ↑ Beran R (2015). "Paraesthesia and peripheral neuropathy". Aust Fam Physician. 44 (3): 92–5. PMID 25770571.
  10. ↑ 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. ↑ 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.
  12. ↑ 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. ↑ 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. ↑ 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.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ 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.
  18. ↑ 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.
  19. ↑ 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.

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