Back to 2012 Annual Meeting Program
Prevalence of Tinel Signs in Diabetics in a Community Setting
S. Shar Hashemi, MD; Isaam Cheikh, MD; A. Lee Dellon, MD, PhD
Johns Hopkins University, Baltimore, MD, USA
Purpose: While it is accepted that chronic nerve compression is more common among people with diabetes, an epidemiologic evaluation of the prevalence of the =84positive Tinel=89 sign, a clinical finding in patients with chronic nerve compression, has never been reported. It is the purpose of this study to evaluate the prevalence of the Tinel sign in the upper and lower extremities of diabetics during their regular office visit with an private practice endocrinologist.
Methods: An IRB-approved, prospective, cross-sectional, descriptive study of 81 consecutive patients (162 sides) being seen with their endocriologist were examined by a fellowship-trained Hand Surgeon, experienced in doing the =84Tinel sign=89. In the upper extremity the known sites of anatomic entrapment were palpated; median nerve at the wrist (CTS), ulnar nerve at the elbow (CU), radial sensory nerve in the forearm (RSN), and a control site 10 cm proximal to the ulnar syloid in the forearm. In the lower extremity, the sites were the tibial nerve at the ankle (TTS), proximal tibial nerve (PTN), the common peroneal nerve at the fibular head CPN), superficial perineal nerve 10 cm proximal to the lateral malleolus (SPN), deep peroneal nerve over dorsum of the foot (DPN), and a control site 10 cm proximal to the medial malleolus. Data regarding presence of neuropathy was obtained with the Michigan Neuropathy Screening Instrument (MNSI). Statistical evaluation included Spearman Correlation Coefficient between positive Tinel sign and MNSI.
Results: 100% of the negative control test sites had an absent Tinel sign. For the diabetics, the Michigan Neuropathy Score and number of positive Tinel signs were highly correlated (coefficient r=3D0.94) for all sites taken together and for individual peripheral nerves. For individual nerves, the prevalence of a positive Tinel sign in this population, with neuropathy is given in Table 1. The prevalence of the Tinel sign was not significantly different bilaterally.
Conclusion: This study documents, for the first time, prevalence of a positive Tinel sign in diabetics receiving care by a community-based endocrinologist. Tinel sign prevalence at least quadrupled in the presence of neuropathy.
Back to 2012 Annual Meeting Program