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Special Test

Semmes Weinstein Monofilament Test

Semmes Weinstein Monofilament Test is a neurological test that is used in sensory loss of the skin.

In Semmes Weinstein Monofilament Test, the palm of the hand is divided into several areas, and only one point (usually in the center) is tested in each area:

  1. Between the fingertip and DIP joint.
  2. Between the DIP joint and PIP joint.
  3. Between the PIP joint and finger web.
  4. Between the finger web and the distal anterior (palmar) crease.
  5. Between the distal anterior (palmar) crease and the central palm.
  6. Base of palm and wrist.
  7. Superficial radial nerve distribution.

The clinician applies a monofilament perpendicular to the surface, and the pressure is increased until the monofilament begins to bend. Filament 2.83 MN is considered the “Normal” filament and indicates normal light touch perception. A positive test for CTS is when the patient with eyes closed cannot report which digit is receiving pressure at 2.83 mg.

See Also: Carpal Tunnel Syndrome
Download Semmes Weinstein Monofilament Test PDF File

Light Touch Testing Scale and Filament Forces Using Semmes Weinstein Monofilament Test

ColorPressure (mg)Monofilament (MN)
Green502.83
Blue2003.61
Purple24.31
Red44.56
Red/orange3006.65
Diagonal redlineNo response0

Diagnostic Usefulness of the Semmes Weinstein Monofilament Test in one study by Koris et al found that this test has a Sensitivity of 82% and a Specificity of 86%.

Another study by Pagel et al. found the Sensitivity of 98% and a Specificity of 15% for the Semmes Weinstein Monofilament Test.

In a study on 36 hands with carpal tunnel syndrome, the Interexaminer Reliability was κ = .22 (.26, .42).

See Also: Weber Two Point Discrimination Test
Semmes Weinstein Monofilaments
Semmes Weinstein Monofilaments

The grades of Semmes-Weinstein Monofilament Test

GradeMonofilament sizeTarget force (gm)Interpretation
61.65-2.830.008-0.07Normal
53.22-3.610.16-0.4Diminished light touch
43.84-4.310.6-2Diminished protective sensation
34.56-4.934-8Loss of protective sensation
25.07-5.8810-60Loss of protective sensation
16.10-6.65100-300Loss of protective sensation/Deep pressure sensation only
0Loss of sensation

References

  1. Koris M, Gelberman RH, Duncan K, Boublick M, Smith B. Carpal tunnel syndrome. Evaluation of a quantitative provocational diagnostic test. Clin Orthop Relat Res. 1990 Feb;(251):157-61. PMID: 2295167. Pubmed
  2. Moberg E: Objective methods for determining the functional value of sensibility in the hand. J Bone Joint Surg Br 40A:454–476, 1958.
  3. Tubiana R, Thomine J-M, Mackin E: Examination of the Hand and Wrist. London: Mosby, 1996.
  4. Omer GE: Report of committee for evaluation of the clinical result in peripheral nerve injury. J Hand Surg 8:754–759, 1983.
  5. Buch-Jaeger N, Foucher G: Correlation of clinical signs with nerve conduction tests in the diagnosis of carpal tunnel syndrome. J Hand Surg Br 19:720–724, 1994
  6. Gellman H, Gelberman RH, Tan AM, et al: Carpal tunnel syndrome. An evaluation of the provocative diagnostic tests. J Bone Joint Surg Am 68A:735–737, 1986.
  7. MacDermid JC, Kramer JF, Woodbury MG, McFarlane RM, Roth JH. Interrater reliability of pinch and grip strength measurements in patients with cumulative trauma disorders. J Hand Ther. 1994 Jan-Mar;7(1):10-4. doi: 10.1016/s0894-1130(12)80035-4. PMID: 8012479.
  8. Raji, Parvin & nakhosin Ansari, Noureddin & Naghdi, Soofia & Forogh, Bijan & Hasson, Scott. (2014). Sensory nerve conduction studies in carpal tunnel syndrome.. NeuroRehabilitation. 35. 10.3233/NRE-141150.
  9. Netter’s Orthopaedic Clinical Examination An Evidence-Based Approach 3rd Edition Book.
  10. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.

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