Sensation exam: how accurate in finding neurological issues in legs?

[mon2013]

Opinion please.


Patient complains lower legs have been aching on and off for a few weeks, sometimes days at a time.
After having applied some sort of self-tanner, patient is blow drying body, and discovers that the portion of legs from above the knee to ankle region felt muted in sensation- like something was sitting on top of their leg, or the leg was half asleep. No pins and needles. No pain. Just that the felt half numb.

Upon a routine sensation (temperature, vibration) were tested, and appeared normal, albeit ever so slightly less in lower legs. For example, the instrument was sharp feeling on the thigh region and feet, but not so on lower legs.

These tests were performed by a GP. The patients eyes were not closed and perhaps proper technique was not used during this exam.

Reflexes were fine. Patient can feel touch.


The question is, can a patient have a seemingly normal sensation test, but still have some sort of mild neurological problem?

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[typhoonegator]

The sensory exam can be fairly insensitive (hah!) when the complaints are vague or are subtle in their presentation. A patient can experience subtle sensory changes that we would have a very hard time picking up on the exam.

Now, if it's just a segment of the lower legs and not in a stocking distribution, it gets a little weirder and would be harder to explain physiologically, but whatever. An early small fiber neuropathy could cause a subtle loss of temperature sensation without an obvious change in pinprick sensation or reflexes. Or the patient might have just realized that their lower legs are less sensitive than their thighs and it means nothing. That's neurology for you.

I had no idea that people had to blow dry self tanner onto their skin. Sounds like a lot of work to look unnaturally orange.

 

[mon2013]

Thank you for your reply.


Yes, this patient did not have a typical stocking distribution. That is to say, the feet were not involved at all. Only the lower legs and above the knees a good three inches. Possibly outer sides of thighs could be involved but was unsure. Is there any reason for this physiologically?


For sensory exams I understand at there are normal variations in temperature and sensation in individuals legs. But with that said....

Patient could feel object as it rolled across lower legs, but when compared to upper legs was not sharp. It was sharp though on upper legs and feet.

For temperature, fronts of shins were not cold at all, while sides of lower legs were said to be much more so.

In everyone's opinion, what is the natural sensory variation typical of legs?


Thanks you!

 

[KLPM]

Is the OP the patient?

I had no idea that people had to blow dry self tanner onto their skin. Sounds like a lot of work to look unnaturally orange.