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When Are Static/Moving Two Point Discrimination and Semmes-Weinstein Monofilament Tests Reliable in Children?
Timothy Patrick Lancaster, BS, Karan Dua, MD; Joshua M. Abzug, MD
University of Maryland School of Medicine, Baltimore, MD

Introduction: Objective sensory testing is a critical component of the physical examination, especially when lacerations occur. This is especially true in children as they may be unable to communicate that numbness is present. The purpose of this study was to determine at what age objective sensory tests can be reliably performed.

Materials and Methods: Normal, uninjured patients aged 2-17 years were enrolled in the study. Monofilament and static/moving two-point discrimination tests were performed bilaterally assessing the median, ulnar, and radial nerves. Three trials were performed for each test in each nerve distribution and the child was considered to be able to perform the test if they answered correctly all three times. Statistical analysis was performed utilizing univariable linear regression, Welch's t-test, and one-way ANOVA.

Results: 139 hands were tested utilizing monofilaments and 127 hands utilizing the two-point discrimination tests. The ulnar and median nerve distributions are more sensitive than the radial nerve during monofilament testing (p <0.0001). For both static and moving two-point discrimination, children display the best discrimination ability in the median nerve distribution, followed by the ulnar nerve, and then the radial nerve (p <.000001). For all nerve distributions, children can better discriminate moving points compared to static points (p <0.0001). Hand dominance generally does not affect monofilament or two-point discrimination scores, except for monofilament testing on the radial nerve, which indicates better sensitivity on the dominant hand (p= 0.04). All children 5 and older in our cohort were capable of performing the monofilament test in comparison to children ages 3 and 4 years (33% and 50%, respectively). The percentage of 5 year olds capable of testing is significantly greater than the percentage of 3 and 4 year olds combined (p = 0.006). All children 7 and older were capable of performing the two-point discrimination tests, which is a significantly greater percentage than for 6 year olds, of whom only 73% were capable (p=0.04).

Conclusion: Objective testing of sensation can be reliably performed in children. Threshold testing utilizing a monofilament can be performed uniformly in children as young as 5 years, and sometimes as young as 3-4 years. Density testing utilizing two-point discrimination can be performed uniformly in children as young as 7 years with decreasing reliability in younger children.

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