Sensitivity of joint position sense test, tuning fork test, Semmes-Weinstein Monofilament Examination and Michigan Neuropathy Screening Instrument in the diagnosis of diabetic polyneuropathy ; Comparação entre o Teste de Senso de Posição Articular (TSPA), Teste do Diapasão (TD), Exame do Monofilamento de Semmes-Weinstein (EMSW) e Instrumento de Rastreio de Neuropatia de Michigan (QMNSI) na sensibilidade do diagnóstico da polineuropatia diabética

Objectives: To compare, in patients with diabetic neuropathy, the prevalence of hallux position perception (joint position sense) test (JPST) abnormalities with tuning fork test (TFT) and Semmes-Weinstein monofilament examination (SWME) abnormalities and with the results of the questionnaire designed for neuropathic symptoms assessment that is part of the Michigan Neuropathy Screening Instrument (QMNSI). Subjects and Methods: This is a retrospective study of 35 ambulatory patients with peripheral diabetic polyneuropathy confirmed by nerve conduction studies. All the patients underwent TFT, SWME, QMNSI and JPST. Severe neuropathy was defined as peripheral neuropathy with no response to the electrical stimulation by any of the motor or sensitive nerves. Results: The prevalence of TFT (63%) and of QMNSI abnormalities (69%) in patients with diabetic neuropathy was significantly greater than JPST abnormalities (25.7%). Prevalence of abnormal JPST and TFT was increased in patients with severe nerve conduction study abnormalities. Concurrent evaluation with TFT, SWME and QMNSI was the most sensitive strategy to diabetic neuropathy diagnosis (sensitivity, 89%). SWME had a particularly low sensitivity (40%). Abnormalities revealed by JPST was significantly more prevalent in patients reporting previous ulcerations (p=0.006). However, JPST did not identify a greater number of patients with prior ulcerations when compared to the other tests. Conclusions: The application of a single test (especially JPST and SWME) in the screening of diabetic neuropathy may lead to a considerably lower sensitivity when compared to the combined use of multiple tests. JPST abnormalities have the potential to indicate a more severe neuropathy and a higher risk of ulcerations. ; Objetivos: Comparar, em uma população com neuropatia diabética, a prevalência de alterações no teste da percepção da posição do hálux (teste do senso de posição articular - TSPA) com o teste do diapasão de 128 Hz (TD), exame do monofilamento de Semmes-Weinstein (EMSW) e ...