Table 1.

Symptoms & signs of small & large fiber DSPN. ³

Type of neuropathy	Subjective symptoms	Objective signs
Small fiber neuropathy	• Hypersensitivity to pressure or touch • Chronic or transient sensations of paresthesias:  ○ tingling  ○ burning  ○ freezing  ○ stabbing  ○ aching  ○ electrical	• Sensory loss: 0 – + (thermal allodynia-cold metallic device or ice in glove) • Pain: 0 – +++ • Tendon reflex: NL – ↓ • Motor Deficit: 0 • Reduced sensitivity:  ○ 1.0 g Semmes Weinstein Monofilament • Reduced prickling pain perception  ○ Waardenberg wheel • Abnormal ANS function (feet and/or hands)  ○ decreased sweating  ○ dry skin  ○ cold feet (impaired vasomotion & blood flow) • Normal NCV findings
Large fiber neuropathy	• Symptoms may be minimal:  ○ sensation of walking on cotton  ○ floors feeling “strange”  ○ inability turn pages of book or button shirt  ○ inability to discriminate among coins • In some cases, with severe distal muscle weakness:  ○ inability to stand on toes or heels	• Sensory loss: 0 – +++ (touch vibration – 128 Hz tuning fork) • Pain: 0 – +++ • Tendon reflex: 0 – ↓↓↓ • Motor Deficit: 0 – +++ • Impaired light touch &/or joint position perception • Abnormal NCV findings • Sensory ataxia (waddling like a duck) • Wasting of small intrinsic muscles of feet &/or hands  ○ hammertoe deformities  ○ weakness hands &/or feet • Increased blood flow – hot feet