Effectiveness of Semmes-Weinstein monofilament examination for diabetic peripheral neuropathy screening.
OBJECTIVE
To evaluate the effectiveness of the Semmes-Weinstein monofilament examination (SWME) for diabetic peripheral neuropathy (DPN) screening at an outpatient clinic.


METHODS
Eighty-two type 2 diabetic outpatients were questioned about 13 subjective symptoms and tested for deep reflexes. They were examined using two types of quantitative sensory testing: SWME (using 4.31/2 g and 5.07/10 g monofilaments) and vibration testing (using the C-64 quantitative tuning fork). The patients were diagnosed with DPN when two of the following three criteria from both legs were met: (1) the presence of either pain, numbness, or paraesthesia; (2) a diminished or absent ankle reflex; or (3) a scale below 4 for their vibration perception thresholds (VPT).


RESULTS
The most common subjective symptoms were muscle cramps and numbness in the extremities. SWME 4.31/2 g at the great toe or the plantar aspect of the fifth metatarsal was the most useful diagnostic test for DPN, providing 60.0% sensitivity and 73.8% specificity. SWME 4.31/2 g was correlated with lower limb VPT (P=.029) and three subjective symptoms including fainting. SWME 5.07/10 g was correlated with lower limb VPT (P=.011), the ankle reflex (P=.013), the knee reflex (P=.031), and two subjective symptoms. However, the sensitivity to diagnose DPN was low (30.0%).


CONCLUSIONS
The abnormalities indicated by SWME correlated well with those identified by lower limb VPT. Moreover, SWME 4.31/2 g correlated with fainting, suggesting that it could detect abnormalities in the small fibers. Considering the minimal time for this examination, SWME 4.31/2 g is a useful examination in an outpatient setting along with lower limb VPT and ankle reflex testing.
Kamei
Nozomu
N
Department of Molecular and Internal Medicine, Division of Clinical Medical Science, Programs for Applied Biomedicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
Yamane
Kiminori
K
Nakanishi
Shuhei
S
Yamashita
Yasuyo
Y
Tamura
Tomoko
T
Ohshita
Kayo
K
Watanabe
Hiroshi
H
Fujikawa
Rumi
R
Okubo
Masamichi
M
Kohno
Nobuoki
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint; D017719:Diabetic Foot / Q000175:diagnosis*; D003929:Diabetic Neuropathies / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009460:Neurologic Examination / Q000295:instrumentation*; D010045:Outpatients; D010812:Physical Stimulation; D012018:Reflex; D014110:Touch; D014732:Vibration