Signs of neuropathy

The term “signs” in the medical field is used to indicate finding that a medical provider looks for on the physical examination to reach a diagnosis. These are explained below in the case of a physical examination to diagnose diabetic neuropathy. For “symptoms”, which in the medical field is the term used to describe your complaints such as numbness, tingling and pain, please refer to the article on “symptoms of neuropathy”.

When a medical provider performs a physical examination to evaluate for diabetic neuropathy, the examination often begins with an assessment off sensation in the upper and lower limbs. Your ability to feel light touch as well as pinprick sensation is assessed. One of the earliest clinical signs of diabetic peripheral neuropathy or polyneuropathy is a decrease or loss of pinprick sensation, followed by decrease or loss of light touch sensation. This is followed by loss of vibration feeling. The feeling of vibration is tested using a tuning fork. Loss of sensation in the “glove and stocking” distribution is often the term used to describe the manner in which most people develop peripheral neuropathy or polyneuropathy. There can be loss of sensation in other parts of the body as well like the chest, trunk or pelvic areas. When neuropathy worsens beyond loss of sensation, there is progression to actual weakness. The remaining part of the “neurological” or nerve testing examination includes an assessment of strength in the upper and lower limbs to look for any weakness.

The physical examination usually also includes testing of deep tendon reflexes, like the ‘knee jerk’. When peripheral neuropathy or polyneuropathy is present, the reflexes can be decreased or absent due to the damage of nerves. But one should keep in mind that it is possible for reflexes to be diminished or absent in certain healthy people as well. Therefore, it is most helpful for your physician to be able to compare your reflexes over time, to see if there is any change from your usual reflexes.

The examination for neuropathy should also include an evaluation of the skin and circulation in the feet and legs, and hands and arms. Changes in the skin color, texture, hair growth, wounds, etc can indicate the severity of neuropathy, and may need treatment.

Certain special functions like vision, taste, smell, movement of the facial muscles, muscles that allow speech, chewing, swallowing, etc are performed with the help of special nerves directly from the brain, called “cranial nerves“. These nerves may also be tested during the complete examination for neuropathy.

Since diabetes can also affect blood circulation, blood vessel pulsations in the feet, legs, hands and arms are usually checked during a physical examination for neuropathy. Most physical examinations will usually also include a check of blood pressure and heart rate, as well as listening for abnormal heart sounds or lung sounds.

Many doctors and medical providers would also check your balance and coordination, since these functions can be affected when neuropathy is present.

If your complaints involve certain organ functions like urinary or bowel problems, sexual problems, etc, or if your doctor suspects that you may have one of the neuropathies that affect specific organs in the body like the bowels, bladder, etc. then there are specific tests on physical examination that the medical provider will want to perform to better evaluate those organ functions.

Since diabetic neuropathy can affect nerves anywhere in the body, a proper physical examination will help reveal any abnormalities or affected areas. Depending on the finding, the medical provider might find it necessary to have certain special tests performed like blood tests, nerve conduction study, electromyography, etc. These will be discussed further in the article ‘Special tests for neuropathy’.