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Sensitivity and specificity of nerve palpation, monofilament testing and voluntary muscle testing in detecting peripheral nerve abnormality, using nerve conduction studies as gold standard; a study in 357 patients.
Lepr Rev. 2009 Mar; 80(1):34-50.LR

Abstract

OBJECTIVE

To determine sensitivity and specificity of clinical tools viz. nerve palpation (NP), monofilament (MF), and voluntary muscle testing (VMT), for assessing peripheral nerve function impairment (NFI) in leprosy, using nerve conduction studies (NCS) as gold standard.

STUDY POPULATION AND METHODS

357 untreated multibacillary (MB) leprosy patients were assessed using above tests. The nerves assessed were left and right ulnar, median, radial cutaneous, sural, common peroneal and posterior tibial. The concordance between the clinical and NCS tests was done for each nerve. The sensitivity and specificity of clinical tests for detecting nerve impairment was determined, using NCS as gold standard. Analysis was performed using SPSS version 10.0.

RESULTS

The sensitivity of NP ranged between 71% to 88% for all nerves, except the median (43%) and sural (59%) nerves. Specificity was > 60% for all, but low for ulnar (34%) and common peroneal (40%) nerves. The specificity of MF testing was > 80% and of VMT assessment was >90% for all nerves. The sensitivity of MF testing ranged between 35-44%, while of VMT assessment was very low i.e. 4-5%, the maximum was for the ulnar nerve (25%). Detection sensitivity of MF testing and VMT assessment improved two fold when combined with NP and was closely comparable to NCS test findings.

CONCLUSIONS

Both MF testing and VMT assessment showed good specificity, but moderate to low sensitivity. NP was less specific but more sensitive than MF testing and VMT assessment. Combining NP with MF testing and VMT assessment gives a two fold improvement in the sensitivity for assessing nerve damage and could therefore serve as the most useful clinical tools for diagnosis of leprosy and detecting nerve damage at field level.

Authors+Show Affiliations

The Foundation for Medical Research, Thadani Marg, Worli, Mumbai 400 018, India.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19472851

Citation

Khambati, Fatema Abbas, et al. "Sensitivity and Specificity of Nerve Palpation, Monofilament Testing and Voluntary Muscle Testing in Detecting Peripheral Nerve Abnormality, Using Nerve Conduction Studies as Gold Standard; a Study in 357 Patients." Leprosy Review, vol. 80, no. 1, 2009, pp. 34-50.
Khambati FA, Shetty VP, Ghate SD, et al. Sensitivity and specificity of nerve palpation, monofilament testing and voluntary muscle testing in detecting peripheral nerve abnormality, using nerve conduction studies as gold standard; a study in 357 patients. Lepr Rev. 2009;80(1):34-50.
Khambati, F. A., Shetty, V. P., Ghate, S. D., & Capadia, G. D. (2009). Sensitivity and specificity of nerve palpation, monofilament testing and voluntary muscle testing in detecting peripheral nerve abnormality, using nerve conduction studies as gold standard; a study in 357 patients. Leprosy Review, 80(1), 34-50.
Khambati FA, et al. Sensitivity and Specificity of Nerve Palpation, Monofilament Testing and Voluntary Muscle Testing in Detecting Peripheral Nerve Abnormality, Using Nerve Conduction Studies as Gold Standard; a Study in 357 Patients. Lepr Rev. 2009;80(1):34-50. PubMed PMID: 19472851.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sensitivity and specificity of nerve palpation, monofilament testing and voluntary muscle testing in detecting peripheral nerve abnormality, using nerve conduction studies as gold standard; a study in 357 patients. AU - Khambati,Fatema Abbas, AU - Shetty,Vanaja Prabhakar, AU - Ghate,Sunil Dattatraya, AU - Capadia,Gospi Dolly, PY - 2009/5/29/entrez PY - 2009/5/29/pubmed PY - 2009/6/24/medline SP - 34 EP - 50 JF - Leprosy review JO - Lepr Rev VL - 80 IS - 1 N2 - OBJECTIVE: To determine sensitivity and specificity of clinical tools viz. nerve palpation (NP), monofilament (MF), and voluntary muscle testing (VMT), for assessing peripheral nerve function impairment (NFI) in leprosy, using nerve conduction studies (NCS) as gold standard. STUDY POPULATION AND METHODS: 357 untreated multibacillary (MB) leprosy patients were assessed using above tests. The nerves assessed were left and right ulnar, median, radial cutaneous, sural, common peroneal and posterior tibial. The concordance between the clinical and NCS tests was done for each nerve. The sensitivity and specificity of clinical tests for detecting nerve impairment was determined, using NCS as gold standard. Analysis was performed using SPSS version 10.0. RESULTS: The sensitivity of NP ranged between 71% to 88% for all nerves, except the median (43%) and sural (59%) nerves. Specificity was > 60% for all, but low for ulnar (34%) and common peroneal (40%) nerves. The specificity of MF testing was > 80% and of VMT assessment was >90% for all nerves. The sensitivity of MF testing ranged between 35-44%, while of VMT assessment was very low i.e. 4-5%, the maximum was for the ulnar nerve (25%). Detection sensitivity of MF testing and VMT assessment improved two fold when combined with NP and was closely comparable to NCS test findings. CONCLUSIONS: Both MF testing and VMT assessment showed good specificity, but moderate to low sensitivity. NP was less specific but more sensitive than MF testing and VMT assessment. Combining NP with MF testing and VMT assessment gives a two fold improvement in the sensitivity for assessing nerve damage and could therefore serve as the most useful clinical tools for diagnosis of leprosy and detecting nerve damage at field level. SN - 0305-7518 UR - https://www.unboundmedicine.com/medline/citation/19472851/Sensitivity_and_specificity_of_nerve_palpation_monofilament_testing_and_voluntary_muscle_testing_in_detecting_peripheral_nerve_abnormality_using_nerve_conduction_studies_as_gold_standard L2 - https://medlineplus.gov/mycobacterialinfections.html DB - PRIME DP - Unbound Medicine ER -