Neuropathy People Symptoms Must Be Aware:
Make sure that the subject knows the type of sensation. Do you feel this as a vibration or a buzzing? As a vibration, very good. Now repeat the procedure in the feet. Again, strike the tuning fork hard enough so that the sides touch and immediately put the tuning fork on the distal interphalangeal joint. Count the number of seconds. Ask the subject to tell you when the vibration stops. Again, the tuning fork goes on the distal interphalangeal joint. Make sure you strike the tuning fork hard enough so that the sides touch.
For evaluating deep tendon reflexes, with the subject seated, the examiner should use the hand to gently dorsiflex the foot about 90 degrees. Press upwards slightly on the sole of the foot. Use a reflex hammer, preferably a long-handled reflex hammer. Tomahawk hammers also acceptable. And strike the Achilles tendon just behind the heel. Contraction of the gastrocnemius muscle will be both seen and felt. Repeat the procedure with the opposite leg. Have to do now is show the discrepancy between the knee reflex and the ankle reflex.
Many patients with HIV disease have both central and peripheral nervous system disease. So one may see a mix of hyperreflexia at the knee and reduced reflexes, or hyporeflexia or areflexia at the ankles. So now we’ll attempt to demonstrate this. So here first for the patella reflex, the knee reflex, this would be graded as a 3plus, there is hyperreflexia and spread of the reflex to other muscles. In the same patient, ankle reflexes are reduced significantly out of proportion to knee reflexes. So these are the different gradings for ankle reflexes.
Absent means that with a strong percussion of the Achilles tendon, there is no contraction of the gastrocnemius. Now you may see some mechanical bounce of the muscle but this is not the same as a contraction. Reduced is where there is a visible contraction of the gastrocnemius. So here we’re seeing visible contraction. Increased is where there’s a strong contraction of gastrocnemius with spread to other muscle reflexes. Here I’m going to attempt to demonstrate the different gradings of ankle reflex in the same individual.
Obviously, this is artificial, but it gives you an idea of the degree of movement of the gastrocnemius after percussion of the Achilles tendon. So first, absent ankle reflexes, the percussion of the Achilles elicits contraction of the gastrocnemius. Be graded as a zero. Reduced reflexes imply that there is a contraction of gastrocnemius but it’s reduced compared to normal. This would be an example of reduced. May take several percussions to elicit a small contraction. If you ask the patient to reinforce, and if we go up to include the knee.
Can we pan up to the knee? I want you to bring your arms down. Bring your arms down like that. Reinforcement may be necessary to bring out a reduced reflex. Reinforcement here just by asking the subject to play tug of war with her hands. The normal reflex is a brisk contraction of the gastrocnemius, it’s reproducible but doesn’tspread to other muscle groups. And the last and final grading is hyperreflexia increased reflexes, where there are a brisk contraction and some spread of reflexes.
Finally, the ankle with a brisk upward movement of the foot into dorsiflexion, with there will be a repetitive movement of the foot. So here we’re gonna demonstrate the discrepancy between knee reflexes and ankle reflexes. I’m gonna touch the patient’s foot here, the knee reflexes are very brisk and will be graded as three-plus. You’ll notice that there is a spread of reflex to other muscle groups other than just the quadriceps. Again, very brisk knee reflexes. Now focusing on the ankle, there’s really no appreciable contraction of the gastrocnemius muscle.
Even with reinforcement there’s no contraction of the gastrocnemius. On close up, this is the knee reflex with an excessive contraction of the quadriceps. Notice the spread of reflexes to abductor and adductor groups. I’ll do it one more time, okay. This will be graded as a three-plus because there is a spread of reflexes. Okay. Now, a close of the gastrocnemius with an absent ankle reflex. No appreciable contraction of the gastrocnemius. Notice that there sometimes a little bit of bounce within the muscle but this is not true contraction.
This is just from the mechanical percussion of the reflex hammer, again this is nota true contraction. This would be graded as zero, with no reflexes. The authors report a sensitivity of 58% but they could not provide any specific percentage. The Tinel sign can be elicited in two places around the ankle. First, there’s the anterior tibial branch of the deep peroneal nerve which you would assess by tapping anterior to the medial malleolus. Secondly, you may be able to elicit the Tinel Sign for the posterior tibial nerve by tapping behind the medial malleolus.
In both cases tingling and paresthesia felt distal is a positive sign. All alright, guys, This was the Tinel Sign at the ankle joint. So neuropathy basically means the sensation of pressure, pain is all decreased. Especially at your feet, the soles of your feet could be your toes. So a lot of patients actually have damage based on this neuropathy. Walking around, it’s easy to step on nails, it’s easy to step on tacks and it’s easy to have that debris in your feet without knowing it.
Signs and symptoms of peripheral neuropathy might include Gradual onset of numbness, prickling, or tingling in your feet or hands, which can spread upward into your legs and arms. Sharp, jabbing, throbbing, or burning pain. Extreme sensitivity to touch.A lot of times I’ve seen patients come into the clinic after they’ve discovered blood on a sock and we have actually found debris in wounds from, again, a patient walking around with no shoes, stepping on a needle, a tack, blocks, broken glass, all kinds of stuff. The patient with neuropathy, we always say too, not even if they have neuropathy, I always say to patients with diabetes, always wear some type of footwear in your home.