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A 66-year-old female asked:

I have idiopathic neuropathy. i do have carpal tunnel but he hasn't done a biopsy. wouldn't help to know if it is small fiber neuropathy?

4 doctor answers10 doctors weighed in
Dr. Jimmy Bowen
Physical Medicine and Rehabilitation 34 years experience
Neuropathy: Small fibers are slow uninsulated fibers that transmit pain and temperature. Large fibers are insulated (myelinated) fibers that are fast and transmit sensation and muscle messages. Carpal tunnel and most peripheral neuropathies are large fiber and can be tested with nerve conduction testing. If you have symptoms consistent with small fiber qsart, sweat testing, and biopsy can be used.
Dr. Michele Arnold
Physical Medicine and Rehabilitation 22 years experience
EMG/NCS: I assume you already had emg/ncs to confirm your neuropathy. If not, that is the place to start. Next step would be some lab tests to rule out common causes of neuropathy. Many idiopathic neuropathies are related to remote toxin exposures, and the true cause may never be found. Small fiber neuropathy is uncommon, but worth an epidermal nerve fiber density test if you have burning in your feet.
Dr. Laurence Kinsella
Neurology 36 years experience
Skin biopsy: Small fiber neuropathy (sfn) usually presents with burning feet, but coexistent carpal tunnel syndrome is a possibility. Sfn is suspected when burning and numbness are present despite a normal nerve conduction test.
Dr. Olav Jaren
Neurology 19 years experience
Neuropathy x 3: If you have idiopathic neuropathy and carpal tunnel syndrome, it is not common that someone would do a biopsy to identify small fiber neuropathy. There is no benefit to learning that, as you would undergo treatment for the other two conditions regardless of the result. The treatments may overlap for these conditions. Hope that helps you.

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Last updated Jan 21, 2019

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