The Michigan Neuropathy Screening Instrument (MNSI) can be used to screen a diabetic patient for peripheral neuropathy. It consists of a screening questionnaire and a brief physical examination. A patient with evidence of neuropathy can then be referred for a more detailed examination. The authors are from the University of Michigan, the Royal Free Hospital in London and San Raffaele Hospital in Milan.
Neuropathy Screening Instrument Questionnaire- 15 questions about feelings in legs and feet.
Each answer is responded to as "yes" or "no".
Screening questionnaire subscore: The total number of "yes" answers are recorded.
The greater the number of "yes" answers, the greater the neuropathy.
Physical Examination
|
Parameter |
Finding |
Points |
|
appearance of right foot |
normal |
0 |
|
|
abnormal |
1 |
|
appearance of left foot |
normal |
0 |
|
|
abnormal |
1 |
|
ulceration of right foot |
absent |
0 |
|
|
present |
1 |
|
ulceration of left foot |
absent |
0 |
|
|
present |
1 |
|
ankle reflexes on right side |
present |
0 |
|
|
present/reinforcement |
0.5 |
|
|
absent |
1 |
|
ankle reflexes on left side |
present |
0 |
|
|
present/reinforcement |
0.5 |
|
|
absent |
1 |
|
vibration perception at right great toe |
present |
0 |
|
|
reduced |
0.5 |
|
|
absent |
1 |
|
vibration perception at left great toe |
present |
0 |
|
|
reduced |
0.5 |
|
|
absent |
1 |
If a foot is abnormal, indicate which of the following are present:
(1) deformity (hammer toes, overlapping toes, halux valgus, joint subluxation, prominent metatarsal heads, and medial convexity (Charcot foot)
(2) dry skin or callus
(3) infection or fissure
examination subscore =
= SUM(points for all 8 parameters)
Interpretation of examination subscore:
• minimum subscore: 0
• maximum subscore: 8
• The higher the score, the greater the neuropathy.
Specialty: Neurology
