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Peripheral Neuropathy

mononeuropathy = single nerve
- Diabetes Mellitus
- Carpal Tunnel Syndrome
mononeuritis multiplex = several isolated nerves
- Polyarteritis nodosa
- Sarcoidosis
polyneuropathy
- motor - Guillain-Barre Syndrome
- sensory - carcinomatosis
- sensorimotor - Alcohol
- autonomic - Diabetes Mellitus

observation
- distal muscle wasting (esp. peroneals)
- footdrop
- Pes Cavus
- Claw toes
- Charcot joints
- Callus formation
- skin ulceration
  - (esp under metatarsal heads)
- foot drop splint by bed
tone
- may be flaccid if severe
power
- distal weakness
reflexes
- absent ankle jerks
- +/- absent knee jerks
Sensation
- loss of pinprick and light touch
  - glove and stocking distribution
- patchy loss to pinprick more marked distally
- loss of vibration sense
  - knees
  - iliac crest
  - sternum
- loss of joint position sense at toes
coordination
gait
- may be seen to lift feet high and "slap" to ground
  - weakness of dorsiflexion
Romberg's
- +ve if impaired JPS
Extras
- examine upper limbs
- dipstick urine
- thickened nerves
  - rare

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