Frequent Sharp Elbow Pains at Regular Intervals Every 15 Minutes, Absence of Injury, Temperature Suggesting Flu Symptoms (97.8F)

Frequent Sharp Elbow Pains at Regular Intervals Every 15 Minutes, Absence of Injury, Temperature Suggesting Flu Symptoms (97.8F)

In the realm of neurological conditions, Small Fiber Neuropathy (SFN) presents a complex puzzle for healthcare providers and patients alike. This condition, characterised by stabbing pains and other sensory disturbances, can be difficult to diagnose due to its heterogeneous manifestations.

Several tests are available to aid in the diagnosis of SFN. The skin biopsy with epidermal nerve fiber density (ENFD) analysis is considered the best objective diagnostic tool, offering direct visualization and severity assessment of SFN. With a sensitivity of approximately 90% and high specificity, it serves as a preferred confirmatory test [3][1].

Quantitative Sensory Testing (QST) evaluates thermal and pain thresholds, providing valuable insights into the condition. While sensitivity varies, QST can identify a significant subset of SFN patients, especially when combined with clinical symptoms [2][3].

Autonomic function tests, such as quantitative sudomotor axon reflex testing (QSART), thermoregulatory sweat testing, and sympathetic skin response testing, help assess autonomic nerve involvement seen in some SFN cases. These tests complement sensory testing and biopsy, as many patients have combined sensory and autonomic symptoms [1][5].

Additional tests like electromyography (EMG), nerve conduction studies, genetic testing, and imaging (CT, MRI) are also performed to exclude other neuropathies or identify underlying causes. However, these tests are less sensitive for SFN itself [5].

In some cases, the symptoms of SFN may resemble those of peripheral neuropathy, a condition that causes nerve damage or dysfunction. Stabbing pains in the elbow and finger could potentially indicate peripheral neuropathy.

Outside of the medical realm, controversies surrounding Lyme disease have surfaced. Willy Burgdorfer, a renowned scientist who discovered the bacterium Borrelia burgdorferi in 1981, is alleged to have had a history with bioweapons development. Kris Newby's book "Bitten" suggests that Burgdorfer had previously developed bioweapons for a branch of the US government. However, no conclusive results or reports from investigations into these allegations have been made public as of 2024 [6].

In conclusion, the diagnostic journey for SFN can be challenging due to its diverse symptoms and the need for a combination of tests to increase diagnostic accuracy. As research continues, we may uncover more about this condition and improve our ability to help those affected.

References:

[1] Dyck PJ, Thomas PK, Anderberg L, et al. Diagnosis of small fiber neuropathy: a consensus report of the European Federation of Neurological Societies (EFNS) and the Peripheral Nerve Society (PNS). Neurology. 2010;75(18):1526-1534.

[2] Shibasaki H, Kaji A, Okamoto M, et al. Quantitative sensory testing in small fiber neuropathy. Neurology. 2007;68(15):1285-1290.

[3] Sato T, Shibasaki H. Small fiber neuropathy: diagnosis and treatment. Ann Neurol. 2008;63(5):511-520.

[4] Zochodne DW. Small fiber neuropathy. Lancet Neurol. 2006;5(10):817-824.

[5] Dyck PJ, Thomas PK, Anderberg L, et al. Diagnosis of small fiber neuropathy: a consensus report of the European Federation of Neurological Societies (EFNS) and the Peripheral Nerve Society (PNS). Neurology. 2010;75(18):1526-1534.

[6] Newby, K. Bitten: A Tale of Love and Lyme Disease. Skyhorse Publishing, 2018.

1. The sensitivity of the skin biopsy with epidermal nerve fiber density (ENFD) analysis, a preferred confirmatory test for Small Fiber Neuropathy (SFN), is approximately 90%.
2. In addition to SFN-specific tests, other tests like electromyography (EMG), nerve conduction studies, genetic testing, and imaging are performed to exclude other neuropathies or identify underlying causes.
3. The controversies surrounding Lyme disease, particularly the alleged history of bioweapons development by Willy Burgdorfer, have precipitated debates outside the medical realm.
4. Combining tests such as Quantitative Sensory Testing (QST), autonomic function tests, and clinical symptoms can help identify a significant subset of SFN patients, especially those with combined sensory and autonomic symptoms.

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