Diagnostic Tests for Hand neuropathy
Hand neuropathy Tests: Book Excerpts
Home Diagnostic Testing
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Hand neuropathy Diagnosis: Book Excerpts
Diagnostic Tests for Hand neuropathy: Online Medical Books
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Peripheral Neuropathy:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Sensory neuropathy symptoms include positive phenomena such as tingling; pins/needles; and burning, cold, or lancinating pain. Physical findings include weakness, fasciculations, atrophy, ataxia, wide-based gait, abnormal sweating, decreased or absent deep tendon reflexes, orthostatic hypotension, hypesthesia surrounded by a zone of hyperesthesia, and vibration or position sense affected before pinprick or temperature sense.
Autonomic neuropathy symptoms include impotence, retrograde ejaculation, diaphoresis, incontinence, urinary retention, constipation, diarrhea, orthostatic dizziness, and flushing. Physical findings include delayed pupillary light response, resting tachycardia, sinus arrhythmia, and orthostatic hypotension.
Sensory loss confined to part of a limb suggests injury to a peripheral nerve, plexus, or spinal root, resulting from trauma, entrapment, or vascular insufficiency. Mononeuropathy multiplex affects multiple nerves over time (e.g., due to diabetes or vasculitis). Polyneuropathy occurs in a stocking-glove distribution starting with the longest nerves, and is due to axonal neuropathy, with a toxic or metabolic origin. Bilaterally symmetrical symptoms are found in polyneuropathy or spinal cord lesions, while unilateral involvement is seen in contralateral disease of the brainstem, thalamus, or cortex.
Injury to large myelinated nerves produces decreased light touch and proprioception with a sensation of “walking on a thick carpet” or imbalance. Injury to medium fibers causes decreased light touch and vibration sense. Injury to small unmyelinated fibers, as occurs in diabetes or amyloidosis, decreases pain and temperature sensation and produces dysesthesias. Disproportionate loss of vibration sense and proprioception compared with pain and temperature sensation occurs with diseases of the dorsal column of the spinal cord (e.g., neurosyphilis, vitamin B 12 deficiency, or multiple sclerosis) and demyelinating polyneuropathy.
Transverse cord lesions produce loss of all modalities below the level of the lesion and a band of hyperalgesia at the level of the lesion. Lateral cord compression is heralded by early sensory changes. Dorsal cord compression affects proprioception and tactile discrimination without pain or temperature loss. Pernicious anemia and tabes dorsalis preferentially affect the dorsal columns.
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Source: Field Guide to Bedside Diagnosis, 2007
Wrist/Hand Pain:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Pain, swelling, and fusiform enlargement of multiple hand joints is characteristic of inflammatory arthritis. Involvement of the DIP joints is seen with psoriatic arthritis, and of the PIP and MCP joints with rheumatoid arthritis. Osteoarthritis involves both the PIP and DIP joints, but the swelling is more bony than soft tissue.
With infection, swelling is most prominent in the dorsum of the hand regardless of the original location.
Grip strength can be compared grossly by simultaneously gripping the examiner’s fingers using both hands, or quantitatively by gripping a tightly rolled, slightly inflated blood pressure cuff.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
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