Chapter 14: The Examination: Evaluation of the Patient With Suspected Peripheral Neuropathy

Objectives

On completion of this chapter, the student/practitioner will be able to:

• Develop an evidenced-based evaluative algorithm for assessment of suspected peripheral neuropathy.

• Develop sufficient knowledge of the cognitive components of the peripheral neuropathy evaluation to enable the practicing therapist to develop valid and reliable psychomotor components of the evaluation.

• Identify important signs and symptoms that may relate to peripheral neuropathy.

Key Terms

• Assessment

• Evaluation

• Peripheral neuropathy

Introduction

The physical examiner encountering a patient with suspected peripheral neuropathy has four primary challenges. The first challenge is to obtain a thorough, comprehensive, and valid oral history of the chief complaint, history of the present illness, past medical history, past surgical history, current and past medications, family history, and review of systems. The second challenge is to perform, as directed by the oral history, a comprehensive physical and functional examination. The third challenge is to review and incorporate key diagnostic findings such as blood indices, radiological data, and electroneuromyogram results into the clinical decision-making algorithm. The fourth challenge is to complete the clinical decision-making algorithm by identifying functional problems and developing time-based functional goals and a goal-oriented intervention.

The Chief Complaint

Following the development of the patient-therapeutic relationship, a good probing question for the part of the interview inquiring about the chief complaint is “So, what brought you here to see me today?” Such an open-ended question encourages the patient to talk. Typically, a patient with neuropathy relates an onset of one or a combination of the following: motor weakness, falls, tonal changes, dyscoordination, sensory loss, ataxia, or autonomic complaints. The practitioner should listen closely to the order in which the patient expresses his or her complaints. Typically, the complaints are presented in the order of the ones that have the most functional impact to ones that have the least functional impact.

History of the Present Illness

Following the patient's brief explanation of what brought him or her to the clinic for evaluation, the practitioner should begin to search for the history of the present illness. Patients often describe their symptoms with simple but descriptive adjectives and phrases, such as “burning,” “tingling,” “clumsiness,” “loss of balance,” “dizziness,” “ache,” and “knifelike pain.” Practitioners should always focus on the time frame of the onset of symptoms. Arbitrary but very useful boundaries have been established to determine if a symptom is acute, subacute, or chronic. Categorizing symptoms as acute (present for days to 4 weeks), subacute (present for 4 weeks to 2 months), or chronic (present for greater than 2 months) is often helpful ...