Dysautonomia: "The finger wrinkling test can be used as a screening test before tilt table testing"

ChookityPop

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Are you currently taking a nitric oxide donor as the improved blood flow from these can influence the result?

I would venture the opinion though that in comparison to the images shown in the Pubmed paper for 'normal wrinkling' in a healthy subject, your fingers are a bit lacking in the same degree of wrinkling at the different time points.
( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892617/ )
I dont think I had taken any Nitric oxide supplements before yesterday. Thanks for letting me know.
 

Pyrrhus

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And an updated review:

Stimulated skin wrinkling as an indicator of limb sympathetic function (Wilder-Smith, 2015)
https://doi.org/10.1016/j.clinph.2014.08.007

Excerpt:
Highlights
• Stimulated skin wrinkling is a measure of limb sympathetic function.
• The underlying vasoconstriction causing stimulated skin wrinkling has been used to standardize and improve testing.
• Studies show evidence of diagnostic usefulness for small fiber neuropathy and cystic fibrosis.

Abstract
Skin wrinkling upon water immersion has been used as an indicator of limb nerve function for more than 80 years. Until recently, routine use of the test has been hampered by a poor understanding of the physiology and lack of standardization.

The process underlying stimulated skin wrinkling has been recently identified as dependent on digital vasoconstriction mediated via sympathetic nerve fibers. Vasoconstriction is postulated to drive wrinkling through loss of digit volume, which induces a negative pressure in the digit pulp and exerts a downward pull on the overlying skin and ultimately results in wrinkles.

Improved test standardization has been achieved through substituting water with EMLA for inducing skin wrinkling. This has made testing much easier and has helped implement stimulated skin wrinkling as a practical routine clinical bedside test.

A literature search identified 10 studies of sufficient quality for evaluating stimulated skin wrinkling as a diagnostic test of sympathetic under or over function. Seven studies provide level 1 or 2 evidence as a diagnostic test of small fiber neuropathy and three provide level 1 or 2 evidence for cystic fibrosis. There is reasonable evidence allowing the test to be employed as a simple and effective marker for small fiber neuropathy and cystic fibrosis.
 

kangaSue

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Another interesting article about the skin wrinkling test;
https://irispublishers.com/ann/full...reflects-neurovascular-coupling.ID.000628.php
Interesting to note mention in this article of a study that observed loss of water immersion skin wrinkling in 3 diabetic patients and evidence of autonomic failure, but not peripheral neuropathy. That is to say that you aren't necessarily going to also have an issue with painful neuropathy where this function (WISW) is impaired.

Regarding the EMLA stimulation wrinkling test, EMLA cream is a readily available topical skin numbing cream containing lidocaine and prilocaine. This cream (or variations of it) are often used for skin numbing when having a tattoo done.

There's a good description of the EMLA stimulation wrinkling test process in this article;

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3759298/
EMLA-Induced Skin Wrinkling for the Detection of Diabetic Neuropathy
 

Pyrrhus

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Interesting to note mention in this article of a study that observed loss of water immersion skin wrinkling in 3 diabetic patients and evidence of autonomic failure, but not peripheral neuropathy.

Thanks for sharing that opinion piece, very interesting. (Of course, if there's autonomic failure in a peripheral nerve, it's still "peripheral neuropathy" by definition, just not the type of painful neuropathy one usually thinks of with diabetes nor the type one usually tests for in nerve conduction studies...)

There's a good description of the EMLA stimulation wrinkling test process in this article;

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3759298/
EMLA-Induced Skin Wrinkling for the Detection of Diabetic Neuropathy

Great link, thanks for sharing! :thumbsup:
 

kushami

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361
My fingers wrinkle normally but I am going to check my toes. I have had a numb patch on both my big toes since the onset of my OI symptoms and ulcerative colitis in my early twenties. The numb patches appeared suddenly and have not spread.
 

Rufous McKinney

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The numb patches appeared suddenly and have not spread.
my right outer foot/toes have been numb (more or less) for at least ten years. Corresponds with my right hand- similarly affected. It also matches up with my right knee and right breast.

I used to think the mouse on the computer, affected my hand, but I haven't used a mouse in six years. and when it intensifies, all the same areas also feel it.
 

kushami

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I found a couple of articles that state the mechanism:
https://onlinelibrary.wiley.com/doi/10.1002/mus.10323
https://pubmed.ncbi.nlm.nih.gov/23302867/

The glabrous skin on human fingers and toes forms wrinkles in response to immersion in water. This wrinkling was previously thought to be the result of osmotic swelling of the stratum corneum, the outermost layer of skin [1].

However, more recent evidence has shown that it is in fact due to a reduction in the volume of the fingertip pulp, caused by vasoconstriction, which in turn is controlled by the autonomic nervous system [25]. In combination with the mechanical properties of the glabrous finger skin, this reduction in pulp volume results in the typical pattern of ridges and valleys on the tips of fingers and toes [1].

The dependence of finger wrinkling on the autonomic nervous system has led to the use of finger wrinkles as a clinical indicator of autonomic function [2,69].

I wondered whether people with Raynaud’s might experience the finger wrinkling also, due to cold, and it seems the answer is yes:
 
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kushami

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I tested my feet by immersing them for 30 mins. I couldn’t find anything on whether toes wrinkle slower than fingers do, or whether they wrinkle to the same extent. They certainly wrinkled a lot less than my fingers did.

So I would say that my fingers are normal and my toes are between grade 1 and 2. But is that normal for toes?

I am nearly 50 and I wonder whether a slow loss of nerve function in the feet might be normal with aging. Pity I didn’t do this test in my twenties!
 

kushami

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P.S. I have something similar to Emla (topical anesthetic used in one study instead of water) and could try that tomorrow.
 
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