Year:
2008
Abstract Number:
2340-PO
Vibration Testing Detects Diabetic Peripheral Neuropathy Earlier than the 10-g Monofilament Current guidelines recommend t Current guidelines recommend testing for diabetic peripheral neuropathy (DPN) with the 10-g monofilament. However, the monofilament test may not become abnormal until neuropathy is advanced. Vibration testing with the 128-Hz tuning fork is recommended as a test for DPN, but no specific method has been agreed upon. We have previously shown that striking the tuning fork so it produces a clanging sound, the Clanging Tuning Fork (CTF) test, yields a reproducible measurement of neuropathy. Average perception of 4 seconds (sec) or less indicates severe neuropathy. We compared the results of both tests in 148 diabetic patients (pts) with CTF scores of 8 sec or less. Monofilament testing was done on 4 sites of each foot (total = 8), the plantar surface of the big toe and the first, third and fifth metatarsals. Monofilament testing was considered abnormal if any one site was insensate. Ulcer history was determined from chart review.
[table1]
In 148 pts with CTF scores of 8 sec or less, 68.2% had a normal monofilament test. In 122 pts with CTF scores indicating severe neuropathy (4 sec or less), 62.3% had a normal monofilament test. In 49 pts with CTF scores of 0 sec, 32.7% still had a normal monofilament test. A history of a diabetic foot ulcer was present in 21 pts, and all of these had CTF scores of 4 sec or less. Five of those with foot ulcers had normal monofilament tests (23.8%). When the CTF score was 5 sec or more, monofilament testing was normal in 96.2% of pts.
This study proves the monofilament test does not become abnormal until late in the course of DPN. Vibration testing with the CTF test detects neuropathy at a much earlier stage. A CTF score of 4 seconds or less was 100% sensitive for ulcer risk, whereas the 10-g monofilament was only 76.2% sensitive.
The CTF vibration test detected DPN earlier and predicted ulcer risk better than the 10-g monofilament. Reliance on the monofilament test alone delays the diagnosis of neuropathy and delays identification of patients at risk for ulcers. Detecting DPN earlier with the CTF test can lead to proper diagnosis of neuropathic symptoms, facilitate prescription of protective footwear, and ultimately prevent ulcers and amputations. DAVID S. OYER, AMINA B. HAI, SUE BETTENHAUSEN, Chicago, IL 2340-PO Chicago, IL Complications - Neuropathy
[table1]
In 148 pts with CTF scores of 8 sec or less, 68.2% had a normal monofilament test. In 122 pts with CTF scores indicating severe neuropathy (4 sec or less), 62.3% had a normal monofilament test. In 49 pts with CTF scores of 0 sec, 32.7% still had a normal monofilament test. A history of a diabetic foot ulcer was present in 21 pts, and all of these had CTF scores of 4 sec or less. Five of those with foot ulcers had normal monofilament tests (23.8%). When the CTF score was 5 sec or more, monofilament testing was normal in 96.2% of pts.
This study proves the monofilament test does not become abnormal until late in the course of DPN. Vibration testing with the CTF test detects neuropathy at a much earlier stage. A CTF score of 4 seconds or less was 100% sensitive for ulcer risk, whereas the 10-g monofilament was only 76.2% sensitive.
The CTF vibration test detected DPN earlier and predicted ulcer risk better than the 10-g monofilament. Reliance on the monofilament test alone delays the diagnosis of neuropathy and delays identification of patients at risk for ulcers. Detecting DPN earlier with the CTF test can lead to proper diagnosis of neuropathic symptoms, facilitate prescription of protective footwear, and ultimately prevent ulcers and amputations. DAVID S. OYER, AMINA B. HAI, SUE BETTENHAUSEN, Chicago, IL 2340-PO Chicago, IL Complications - Neuropathy
Congress:
68th Scientific Sessions (2008)
Category:
Complications - Neuropathy