Validity of Clinical Small–Fiber Sensory Testing to Detect Small–Nerve Fiber Degeneration

Ridehalgh, Colette; Sandy-Hindmarch, Oliver; Schmid, Annina B.

doi:10.2519/jospt.2018.8230

Cited by 24 publications

(19 citation statements)

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“…coin for testing temperature). Evidence to support SQST to detect small fibre nerve degeneration is limited [40] and yet to be investigated in participants with LBLP. The sensory profiles of those with NP in LBLP is not known and therefore support for SQST in identifying NP in LBLP is inconclusive.…”

Section: Patient History and Clinical Examinationmentioning

confidence: 99%

Diagnostic utility of patient history, clinical examination and screening tool data to identify neuropathic pain in low back related leg pain: a systematic review and narrative synthesis

Mistry

Heneghan

Noblet

et al. 2020

BMC Musculoskelet Disord

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Background: Low back-related leg pain (LBLP) is a challenge for healthcare providers to manage. Neuropathic pain (NP) is highly prevalent in presentations of LBLP and an accurate diagnosis of NP in LBLP is essential to ensure appropriate intervention. In the absence of a gold standard, the objective of this systematic review was to evaluate the diagnostic utility of patient history, clinical examination and screening tool data for identifying NP in LBLP. Methods: This systematic review is reported in line with PRISMA and followed a pre-defined and published protocol. CINAHL, EMBASE, MEDLINE, Web of Science, Cochrane Library, AMED, Pedro and PubMed databases, key journals and the grey literature were searched from inception to 31 July 2019. Eligible studies included any study design reporting primary diagnostic data on the diagnostic utility of patient history, clinical examination or screening tool data to identify NP in LBLP, in an adult population. Two independent reviewers searched information sources, assessed risk of bias (QUADAS-2) and used GRADE to assess overall quality of evidence. Results: From 762 studies, 11 studies were included. Nine studies out of the 11 were at risk of bias. Moderate level evidence supports a cluster of eight signs (age, duration of disease, paroxysmal pain, pain worse in leg than back, typical dermatomal distribution, worse on coughing/sneezing/straining, finger to floor distance and paresis) for diagnosing lumbosacral nerve root compression, demonstrating moderate/high sensitivity (72%) and specificity (80%) values. Moderate level evidence supports the use of the StEP tool for diagnosing lumbar radicular pain, demonstrating high sensitivity (92%) and specificity (97%) values.

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Section: Patient History and Clinical Examinationmentioning

confidence: 99%

Diagnostic utility of patient history, clinical examination and screening tool data to identify neuropathic pain in low back related leg pain: a systematic review and narrative synthesis

Mistry

Heneghan

Noblet

et al. 2020

BMC Musculoskelet Disord

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“…While previous research has evaluated low‐cost alternatives of QST for clinical use, most studies were aimed at identifying a specific condition, for instance radicular pain (Scholz et al, ) or small fibre degeneration (Haussleiter et al, ; Ridehalgh et al, ). We are aware of only three studies which made a direct comparison of simple CSTs with standardized QST (Buliteanu et al, ; Haussleiter et al, ; Leffler & Hansson, ).…”

Section: Discussionmentioning

confidence: 99%

“…Some QST parameters were represented by more than one CST test. The CST battery was based on the previously published standardized evaluation of pain (StEP) protocol (Scholz et al, ) as well as on previous work from our laboratory (Ridehalgh et al, ). Participants were tested on an unaffected, symptom‐free control area first (CTS: ipsilateral lateral upper arm, NSNAP/LR: contralateral mirror site) followed by the affected area as outlined in the QST methodology above (CTS: index finger, NSNAP/LR: maximal pain area).…”

Section: Methodsmentioning

confidence: 99%

“…Forty-four healthy subjects (proportionally matched for age and gender) were recruited in Oxford, UK and Gold Coast, Queensland, Australia to establish z-scores for QST data in the CTS cohort. Part of the data from this cohort has previously been published (Baselgia, Bennett, Silbiger, & Schmid, 2017;Ridehalgh, Sandy-Hindmarch, & Schmid, 2018;Schmid et al, 2014).…”

Section: Participantsmentioning

confidence: 99%

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Concurrent validity of a low‐cost and time‐efficient clinical sensory test battery to evaluate somatosensory dysfunction

Zhu

Böttger

Slater

et al. 2019

European Journal of Pain

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BackgroundThis study describes a low‐cost and time‐efficient clinical sensory test (CST) battery and evaluates its concurrent validity as a screening tool to detect somatosensory dysfunction as determined using quantitative sensory testing (QST).MethodThree patient cohorts with carpal tunnel syndrome (CTS, n = 76), non‐specific neck and arm pain (NSNAP, n = 40) and lumbar radicular pain/radiculopathy (LR, n = 26) were included. The CST consisted of 13 tests, each corresponding to a QST parameter and evaluating a broad spectrum of sensory functions using thermal (coins, ice cube, hot test tube) and mechanical (cotton wool, von Frey hairs, tuning fork, toothpicks, thumb and eraser pressure) detection and pain thresholds testing both loss and gain of function. Agreement rate, statistical significance and strength of correlation (phi coefficient) between CST and QST parameters were calculated.ResultsSeveral CST parameters (cold, warm and mechanical detection thresholds as well as cold and pressure pain thresholds) were significantly correlated with QST, with a majority demonstrating >60% agreement rates and moderate to relatively strong correlations. However, agreement varied among cohorts. Gain of function parameters showed stronger agreement in the CTS and LR cohorts, whereas loss of function parameters had better agreement in the NSNAP cohort. Other CST parameters (16 mN von Frey tests, vibration detection, heat and mechanical pain thresholds, wind‐up ratio) did not significantly correlate with QST.ConclusionSome of the tests in the CST could help detect somatosensory dysfunction as determined with QST. Parts of the CST could therefore be used as a low‐cost screening tool in a clinical setting.SignificanceQuantitative sensory testing, albeit considered the gold standard to evaluate somatosensory dysfunction, requires expensive equipment, specialized examiner training and substantial time commitment which challenges its use in a clinical setting. Our study describes a CST as a low‐cost and time‐efficient alternative. Some of the CST tools (cold, warm, mechanical detection thresholds; pressure pain thresholds) significantly correlated with the respective QST parameters, suggesting that they may be useful in a clinical setting to detect sensory dysfunction.

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“…Resulta de suma importancia destacar que, ante este escenario, es útil complementar el examen con la evaluación de las fibras finas por la percepción de sensaciones punzantes agudas y umbral de temperatura mediante el test sensorial cuantitativo. Es más, Ridehalgh y Schmid (47), proponen que no es necesaria la biopsia de piel para objetivar la reducida inervación y disfunción de umbrales de presión y temperatura, sino que se puede usar en la clínica un mondadientes y una moneda (fría/caliente) para el mismo fin: simular un test sensorial. Para descartar la degeneración de fibra pequeña, tanto el umbral de detección de frío como el umbral de detección de calor deben ser negativos.…”

Section: Daño Neuralunclassified

Consideraciones para el examen clínico del Síndrome de Opérculo Torácico neurogénico inespecífico

Pacheco

Rodríguez

2020

Rev. Soc. Esp. Dolor.

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El síndrome del opérculo torácico (SOT) es una condición causada por la compresión de las estructuras neurovasculares en su paso entre cuello y tórax. Se clasifica en vascular y neurogénico. Si las pruebas electrofisiológicas no son positivas, se subclasifica como neurogénico inespecífico. Este último constituye entre el 95 y el 98 % de los casos, pero aún no están claros sus criterios diagnósticos. En el presente artículo se revisan los principales aspectos a tener en cuenta durante el examen clínico para guiar el diagnóstico de los pacientes con SOT neurogénico inespecífico, como sintomatología, factores desencadenantes, diagnóstico diferencial, escalas de valoración y factores psicosociales. Palabras clave: Síndrome de opérculo torácico, compresión neurovascular, cervicobraquialgia, diagnóstico diferencial.

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Validity of Clinical Small–Fiber Sensory Testing to Detect Small–Nerve Fiber Degeneration

Abstract: Diagnosis, level 2. J Orthop Sports Phys Ther 2018;48(10):767-774. Epub 22 Jun 2018. doi:10.2519/jospt.2018.8230.

Cited by 24 publications

References 24 publications

Diagnostic utility of patient history, clinical examination and screening tool data to identify neuropathic pain in low back related leg pain: a systematic review and narrative synthesis

Diagnostic utility of patient history, clinical examination and screening tool data to identify neuropathic pain in low back related leg pain: a systematic review and narrative synthesis

Concurrent validity of a low‐cost and time‐efficient clinical sensory test battery to evaluate somatosensory dysfunction

Consideraciones para el examen clínico del Síndrome de Opérculo Torácico neurogénico inespecífico

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