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

[ChookityPop]

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]

Great Twitter thread:

https://twitter.com/i/web/status/1017179836320710657

 

[Pyrrhus]

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]

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]

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!