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European Journal of Plastic Surgery

Published in:

01-08-2017 | Original Paper

Analysis of the two-point discrimination test in daily routine practice

Authors: Cedric E Boesch, Fabian Medved, Manuel Held, Dominik Bender, Hans-Eberhard Schaller, Thomas Fuchsberger

Published in: European Journal of Plastic Surgery | Issue 4/2017

Abstract

Background

Finger nerve lesions lead to a sensory deficit with para-anesthesia or anesthesia and impair hand functions. In daily clinical practice, the diagnosis of an injured finger nerve can be challenging. This study aims at evaluating if the two-point discrimination (2PD) test is a good predictor of nerve lesions to indicate operative treatments in hand trauma patients.

Methods

Based on the record of patients with an acute hand and finger injury, it was evaluated whether a pathological 2PD test in the clinical examination corresponds to the intraoperative findings of a severed nerve. From 2008 and 2014, patients with isolated finger nerve lesions were included, while patients with concomitant bone or tendon injuries were excluded.

Results

As many as 113 patients with a total of 131 nerve injuries of the hand and fingers were suitable for this study. The statistical analysis revealed a sensitivity of 98% among them for the 2PD test. Further, a positive predictive value of 96% was demonstrated.

Conclusions

The results of our study showed that the 2PD test is a valuable examination to diagnose nerve injuries of fingers in hand trauma patients. It is a simple, reliable, and available examination tool and therefore can be suggested in daily clinical practice.

Level of Evidence: Level III, diagnostic study.

Dahlin L (2006) Nerve injury and repair: from molecule to man. In: Slutsky DJ, Hentz VR (eds) Peripheral nerve surgery-practical applications in the upper extremity. Elsevier/Churchill Livingstone, Philadelphia, PA, pp. 1–22

Noble J, Munro CA, Prasad VS, Midha R (1998) Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. J Trauma 45(1):116–122CrossRefPubMed

Rosberg H, Carlsson K, Höjgård S, Lindgren B, Lundborg G, Dahlin L (2005) Injury to the human median and ulnar nerves in the forearm–analysis of costs for treatment and rehabilitation of 69 patients in southern Sweden. J Hand Surg Br 30(1):35–39CrossRefPubMed

Weber E (1835) Ueber den tastsinn. Arch Anat Physiol Wissensch Med 52:152

Dellon AL (1978) The moving two-point discrimination test: clinical evaluation of the quickly adapting fiber/receptor system. J Hand Surg Am 3(5):474–481CrossRefPubMed

Lundborg G, Rosén B (2004) The two-point discrimination test–time for a re-appraisal? J Hand Surg Br 29(5):418–422CrossRefPubMed

Kretschmer T, Birch R (2011) Management of acute peripheral nerve injuries. In: Winn HR (ed) Youmans neurological surgery, 6th edn. Elsevier/Churchill Livingstone, Philadelphia, PA, pp. 2465–2485CrossRef

Birch R (2005) Nerve repair. In: Green DP, Hotchkiss RN, Pederson WC, Wolfe SW (eds) Green’s operative hand surgery, 5th edn. Elsevier/Churchill Livingstone, Philadelphia, PA, pp. 1075–1112

Rosén B, Lundborg G (2004) Sensory re-education after nerve repair: aspects of timing. Handchir Mikrochir Plast Chir 36(1):8–12CrossRefPubMed

10.

Jerosch-Herold C (2005) Assessment of sensibility after nerve injury and repair: a systematic review of evidence for validity, reliability and responsiveness of tests. J Hand Surg Br 30(3):252–264CrossRefPubMed

11.

Shimokata H, Kuzuya F (1995) Two-point discrimination test of the skin as an index of sensory aging. Gerontology 41(5):267–272CrossRefPubMed

12.

Mailänder P, Schaller E, Berger A, Ruhe K (1989) Return of static and moving 2-point discrimination following nerve reconstruction. Handchir Mikrochir Plast Chir 21:299–301PubMed

13.

Moberg E (1962) Criticism and study of methods for examining sensibility in the hand. Neurology 12:8–19CrossRefPubMed

14.

Dellon AL, Mackinnon SE, Crosby PM (1987) Reliability of two-point discrimination measurements. J Hand Surg Am 12(5):693–696CrossRefPubMed

15.

Millesi HRD (1979) Sensory rehabilitation. Proceedings of the World Federation Occupational Therapy 7:122–125

Title: Analysis of the two-point discrimination test in daily routine practice
Authors: Cedric E Boesch
Fabian Medved
Manuel Held
Dominik Bender
Hans-Eberhard Schaller
Thomas Fuchsberger
Publication date: 01-08-2017
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Plastic Surgery / Issue 4/2017
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI: https://doi.org/10.1007/s00238-016-1265-8

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Springer Medicine

Analysis of the two-point discrimination test in daily routine practice

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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