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Primary care diagnosis of length dependent peripheral neuropathy in the setting of metabolic syndrome is currently poorly sensitive. Although brief history questions can recognize patients with positive neuropathy symptoms (e.g. neuropathic pain, paresthesia), many patients with metabolic syndrome or diabetes have neuropathic distal large fiber joint position and vibratory sensory loss that is asymptomatic, but places patients at risk for sensory ataxia, falls and injury. Recognition of neuropathy early in its course can prompt additional etiological testing and lifestyle modification. A simple, sensitive large fiber sensory screening modality is needed.

Peripheral neuropathy, length dependent sensory loss, numbness and pain due to metabolic injury of peripheral nerve fibers, affects 2% of adults, 5-7% of those over 65 years old, and up to 50% of patients with type 2 diabetes. Early recognition of peripheral neuropathy by widespread screening can facilitate diagnosis and appropriate treatment. Most routine screening takes place in a Primary Care physician’s office, and currently consists of a brief foot exam for wounds or skin lesions and use of a 10-gram monofilament to test pressure sensation at the great toe. This common clinical practice has poor diagnostic sensitivity. Monofilament testing detects only moderate to severe proprioceptive sensory loss, often at a threshold at which falls, or unrecognized injury, infection and gangrene are risks. Perception of vibration tests the same class of peripheral nerve fibers, but with greater sensitivity to early nerve injury. An alternative method, timed vibration with a 128 Hz tuning fork, tests the same class of peripheral nerve fibers, but with greater sensitivity to early nerve injury. However, in reliability testing we performed with Medical Assistants at Greenwood Clinic, a Primary Care Venue associated with the University of Utah, 128 Hz tuning fork testing proved technically difficult to deploy accurately. Therefore, there is an opportunity to greatly improve diagnostic sensitivity in Primary Care neuropathy screening with the use of a handheld device that accurately measures vibration threshold at the great toe. Neurosense will make it easy, fast, and accurate to screen for early neuropathy in this common point of service setting.

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