Timed Vibration Sense and Joint Position Sense Testing in the Diagnosis of Distal Sensory Polyneuropathy

Abstract

Introduction: Distal sensory polyneuropathy (DSP) is one of the most common neurological disorders. Although several studies have studied the role of the neurological examination in DSP, there are only limited studies on the utility of timed vibration sense (VBS) and joint position sense (JPS) testing in the diagnosis of DSP. Objectives: The objective is to study the utility of timed VBS testing and JPS testing at the great toe in clinical detection of DSP. Methods: This study was prospectively conducted in the neurology department of a tertiary care hospital in India. Patients with DSP referred to the electrophysiology laboratory from August 2017 to December 2017 were screened. Patients with symptomatic DSP which was confirmed by electrophysiological studies were taken as cases and normal participants with no symptoms or electrophysiological findings suggestive of DSP served as controls. Results: We studied 127 patients and 194 controls. The mean age of the patients was 48.7 (14.5) years in the patient group and 39.7 (14.5) years in the control group. The male: female ratio was 77/50 in the patient group and 112/82 in the control group. Abnormal clinical examination was found in 95% of the patients with DSP. The most common abnormal examination components were impaired ankle reflexes (70%), vibration (85%), and JPS (39.6%) sensation. Using the receiver operating characteristic curve for the diagnosis of DSP, a vibratory response lasting <8 s at the great toe had a sensitivity of 85% and specificity of 42.8%. For JPS testing at the great toe, obtaining two or more incorrect responses had a sensitivity of 33% and specificity of 87.6%. Conclusion: VBS testing was more sensitive and JPS testing was more specific in making a clinical diagnosis of DSP. For timed VBS, duration of >8 s at the great toe was a useful test to rule out DSP, and for JPS testing at the great toe, obtaining two or more incorrect responses was a useful test in ruling in the diagnosis of DSP.

Timed Vibration Sense and Joint Position Sense among Male University Students Experiencing Phantom Vibration Syndrome, Affecting Their Lifestyle

“…Timed vibration sense among university male students were within the normal ranges 2-8 seconds which revealed no statistically significant differences in the great toe left and right, left leg medial and lateral malleoli, and greater trochanter left and right (p > 0.050) [ 9 ] ( Table 1 , Fig. 1 ).…”

“…The subjects were asked to detect and report the direction of movement after the great toe was lightly held at the sides with the thumb and index finger and moved up or down randomly by at least 20°. 10 trials were completed, with the number of accurate trials being recorded [ 9 ].…”

“…To avoid touching the vibrating tines, the examiner gripped the tuning fork stem with two fingers, akin to clutching a dart. A timer was used to record the start of the VBS and the end of the VBS [9]. 1 shows median value for time vibration sense test for the participants.…”

Chemotherapy-Induced Peripheral Neuropathy (CIPN) in Patients Receiving 4-6 Cycles of Platinum-Based and Taxane-Based Chemotherapy: A Prospective, Single-Center Study from Kosovo

“…Time passed from the activation of the tuning fork and its placement until the cessation of vibration feeling by the patient was recorded and compared to the examiner’s perception. Earlier cessation of feeling by the patient was considered pathologic [ 24 ].…”

Why Do Falls and Lower Limb Fractures Occur More Frequently in the Diabetic Patient and How Can They Be Prevented?

“…However, the association of diabetic neuropathy and falls may be even greater in those with decreased proprioception as assessed by a defect in joint position sense. In a cross-sectional study of patients with diabetic neuropathy diagnosed by clinical assessment and electrophysiologic studies, 85% had decreased vibratory sensibility, 70% absent ankle reflex and only 39.6% had decreased joint position defined as two or more errors in a trial of ten toe positions; however, the study lacks data on the severity of the distal sensory neuropathy [15]. The decreased joint position sense indicates sensory deterioration and frequently occurs in conjunction with muscle atrophy.…”