The Michigan Diabetic Neuropathy Score (MDNS)

Description

The Michigan Diabetic Neuropathy Score (MDNS) can be used to evaluate a patient with diabetes mellitus for peripheral neuropathy. It can used in conjunction with screening tests such as the Michigan Neuropathy Screening Instrument (MNSI) to confirm the presence of a neuropathy. The score can be monitored over time to evaluate disease progression.

Clinical examination:

(1) sensory: vibration in great toe, touch with 10 gram filament, pin prick to great toe

(2) muscle strength: finger spread, great toe extension, ankle dorsiflexion

(3) reflex testing: biceps brachii, triceps brachii, quadriceps femoris, Achilles

Nerve conduction studies:

(1) sural nerve

(2) peroneal motor

(3) median sensory nerve

(4) median motor nerve

(5) ulnar sensory nerve

Clinical Examination Test	Finding	Points
vibration in right great toe	normal	0
	decreased	1
	absent	2
vibration in left great toe	normal	0
	decreased	1
	absent	2
10 gram filament test to right great toe	normal (8-10 of 10)	0
	decreased (1-7 of 10)	1
	absent (0 of 10)	2
10 gram filament test to left great toe	normal (8-10 of 10)	0
	decreased (1-7 of 10)	1
	absent (0 of 10)	2
pin prick to dorsum of right great toe	painful	0
	not painful	2
pin prick to dorsum of left great toe	painful	0
	not painful	2
right hand finger spread muscle strength	normal	0
	mild to moderate	1
	severe	2
	absent	3
left hand finger spread muscle strength	normal	0
	mild to moderate	1
	severe	2
	absent	3
right great toe extension muscle strength	normal	0
	mild to moderate	1
	severe	2
	absent	3
left great toe extension muscle strength	normal	0
	mild to moderate	1
	severe	2
	absent	3
right ankle dorsiflexion muscle strength	normal	0
	mild to moderate	1
	severe	2
	absent	3
left ankle dorsiflexion muscle strength	normal	0
	mild to moderate	1
	severe	2
	absent	3
right biceps brachii reflex	present	0
	present with reinforcement	1
	absent	2
left biceps brachii reflex	present	0
	present with reinforcement	1
	absent	2
right triceps brachii reflex	present	0
	present with reinforcement	1
	absent	2
left triceps brachii reflex	present	0
	present with reinforcement	1
	absent	2
right quadriceps femoris reflex	present	0
	present with reinforcement	1
	absent	2
left quadriceps femoris reflex	present	0
	present with reinforcement	1
	absent	2
right Achilles tendon reflex	present	0
	present with reinforcement	1
	absent	2
left Achilles tendon reflex	present	0
	present with reinforcement	1
	absent	2

where:

• In the 10 gram filament testing, the dorsum of the great toe is touched 10 times. The number of correct reports of touching is recorded.

sensory impairment subscore =

= SUM(points for sensory testing on left and right sides)

motor strength subscore =

= SUM(points for muscle strength testing on left and right sides)

reflex subscore =

= SUM(points for reflex testing on left and right sides)

clinical examination score =

= (points for sensory impairment) + (points for motor strength) + (points for reflexes)

Nerve Conduction Studies	Finding	Points
sural nerve	normal	0
	abnormal	1
peroneal motor	normal	0
	abnormal	1
median sensory	normal	0
	abnormal	1
median motor	normal	0
	abnormal	1
ulnar sensory	normal	0
	abnormal	1

abnormal nerve conduction studies =

= SUM(points for nerve conduction studies)

Interpretation:

• minimum score for clinical exam: 0

• maximum score for clinical exam: 46

• minimum score for nerve conduction studies: 0

• maximum score for nerve conduction studies: 5

• The higher the score, the greater the neuropathy.

Clinical Examination Score	Neuropathy
0 – 6	no
7 – 12	mild
13 – 29	moderate
30 - 46	severe

Abnormal Nerve Conduction Score	Neuropathy
0 – 1	no
2	mild
3 – 4	moderate
5	severe

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Description

Specialty

Objective

ICD-10

The Michigan Diabetic Neuropathy Score (MDNS)

Purpose: To evaluate a patient with diabetes for neuropathy using the Michigan Diabetic Neuopathy Score (MDNS).

Description

Specialty

Objective

ICD-10