Click on a specialty listed below for a brief description of how specialists in these fields use the sNCT/CPT to help evaluate and diagnose their patients. Also see the Neurometer CPT Utilization Guidelines page for additional information about the clinically appropriate use of the sNCT/CPT evaluation procedure.
Anesthesiology
The CPT evaluation provides the anesthesiologist with a means to objectively quantify the efficacy of an anesthetic therapeutic intervention resulting from either a peripheral nerve block or spinal or epidural administration of an anesthetic agent. Post-operatively, the CPT evaluation can be used to confirm recovery of sensory functioning in such patients as well. Additionally, the CPT evaluation is utilized for pre and post-op screening of peri-operative peripheral nerve injuries, such as ulnar neuropathy resulting from cubital tunnel compression while under anesthesia.
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Chiropractic
Chiropractors use the sNCT/CPT evaluation to assist in the differential diagnosis and quantitative evaluation of conditions resulting in sensory dysfunction. Chiropractic patients may be administered the sNCT/CPT evaluation when sensory neurologic signs or symptoms are detected which require an objective quantitative evaluation for differential diagnostic and or assessment purposes. Results of the sNCT/CPT evaluation by be used to assist in establishing a treatment protocol or if a referral is indicated. The absence of abnormal measures indicates that no further testing is needed.
The sNCT/CPT evaluation may be repeated to establish the outcome of therapeutic intervention and to determine maximum medical improvement. If a clinical evaluation is equivocal in determining the efficacy of therapeutic intervention with respect to the sensory symptomatology, a repeat examination may be conducted following four to six weeks of therapy. An extenuating circumstance, such as an exacerbation of an existing condition or the development of new sensory neurological impairments, may warrant a repeat sNCT/CPT evaluation.
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Dentistry
The CPT evaluation provides the dentist and oral surgeon a means to evaluate nerve blocks, focal lesions and sensation within the oral cavity.
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Endocrinology
Endocrinologists use sNCT/CPT studies to objectively evaluate metabolic polyneuropathies commonly observed in clinical endocrinology. sNCT/CPT evaluations of patients suspected of having a polyneuropathy objectively assess the presence or absence of this condition and permits evaluation of its severity and progression. Particular concern is given to evaluating protective sensation. Normal sNCT/CPT evaluation results indicate that no further sNCT/CPT testing is necessary unless a change in the clinical condition suggesting new sensory dysfunction warranting an evaluation. Patients with certain types of endocrine disorders (e.g. diabetes) are susceptible to developing compressive neuropathies and radiculopathies and testing for these conditions may be required based upon the clinical necessity.
CPT Evaluations of Diabetic Polyneuropathy:
According to the CDC, 4.3% of the population of the United States has diabetes. Fourteen point seven per cent (14.7%) of our health care dollars are spent on the treatment of diabetes and related illnesses. Lawrence Gavin, M.D., F.R.C.P., F.A.C.P. notes that 20% of all diabetes are hospitalized annually for care of diabetic foot and resulting complications. 50% of all non-traumatic major limb amputations are performed on diabetics; over 50,000 amputations annually. Dr. Gavin's research indicated that over $1 billion dollars is spent annually in this country on the treatment of diabetes.
The DCCT study on complications in diabetes, released in September 1993, demonstrated that complications associated with diabetes such as neuropathy, nephropathy and retinopathy can be avoided or minimized by tight control of the patient's blood sugar. As blood sugar is a transient and highly variable measurement, it is imperative to have a test measurement that will act as a "tattletale" for slow, steady state changes in the patient's condition. Diabetic patients presenting with symptoms of pain, numbness, tingling or transient paresthesias in the extremities need to be evaluated to determine if the symptoms are neuropathic or vascular in origin.
Traditionally, NCV's have lacked the resolving power necessary to detect early neuropathy. This is due to the fact that NCV's can only evaluate degeneration in the nerve. CPT permits diagnosis of early neuropathy due to its ability to diagnose and quantify hyperesthesia, which is known to correlate with inflammation or irritation of the nerve, the earliest stage of neuropathy. CPT testing used at regular intervals (e.g., annually or semiannually) allows the clinician to safely and accurately detect the early stages of or monitor the progression of diabetic neuropathy. Repetitive testing also allows the clinician an opportunity to evaluate the efficacy of any therapeutic intervention, thereby maximizing the benefit with the minimal amount of treatment. The 1995 ADA Standards of Medical Care for Patients with Diabetes Mellitus recommends examination of the feet for assessment of sensation at the initial visit and at subsequent visits. CPT testing provides a major advantage in this type of testing due to the non-aversive nature of the test. Patients are far more likely to return for follow-up testing if the test is painless. CPT testing, if used judiciously for initial diagnosis and subsequent evaluation of the patient's status through the course of their disease, can result in significant savings - both financially and in patient suffering.
An additional discussion about the evaluation of diabetic neuropathy using the sNCT/CPT evaluation can be found in the following Neurometer CPT Techinical Report.
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Family Practice & Internal Medicine
The primary care provider performs sNCT/CPT studies to assist in the differential diagnosis of polyneuropathy, compressive/focal neuropathy and radiculopathy. This electrodiagnostic study is only administered when clinical findings suggest a sensory impairment requiring an objective quantitative assessment. Typically, the study is only conducted once on a patient unless there is the development of new sensory symptoms which warrant an evaluation.
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Nephrology
Nephrologists use sNCT/CPT studies to evaluate patients with kidney disease to assist in determining when to commence dialysis therapy. The study is prescribed when clinical examination findings suggest development of an impairment in distal sensory function and an objective evaluation is required to confirm and evaluate a diagnosis of polyneuropathy. Typically, the distal great toe test site is tested bilaterally and if a polyneuropathy is detected then dialysis therapy may be considered to attempt to reverse the condition and/or prevent its progression. Normal sNCT/CPT evaluation results indicate that no further sNCT/CPT testing is necessary unless a change in the clinical condition suggesting sensory dysfunction requires an evaluation. Nephrologists also prescribe the sNCT/CPT study to be administered to endstage renal disease patients to provide an index of the long-term adequacy of dialysis therapy.
Additionally, sNCT/CPT studies of the distal phalanges of the fingers may assist in the diagnosis of suspected Carpal Tunnel Syndrome (CTS) in dialysis patients. Fifty percent of patients receiving dialysis for six years or more develop CTS without experiencing the classical CTS symptoms due to concurrent upper extremity polyneuropathy. Left untreated, patients with CTS may suffer significant impairment of the affected hand.
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Neurology
Neurologists conduct sNCT/CPT studies to objectively evaluate and localize the distribution of sensory dysfunction associated with conditions, such as symmetric or asymmetric inherited and acquired sensory polyneuropathies and assist in differentiating C - 3 Neurometer® sNCT®/CPT™ Overview & References • © 2002-3 Neurotron, Inc., Balto., MD, USA whether they are myelinopathies or axonopathies. sNCT/CPT evaluations are used to objectively evaluate a suspected sensory impairment and assess disease progression and the efficacy of therapeutic intervention. Follow-up evaluations are generally only required when: 1) there is a clinical question as to whether the patients sensory pathology is deteriorating or 2) there is a clinical question as to whether the patients sensory impairment is responding to therapeutic intervention. sNCT/CPT studies may be prescribed for neuroselective assessment and monitoring of CNS sensory function following CNS vascular events and other types of CNS pathology (e.g. multiple sclerosis or spinal cord pathology that effects cutaneous sensory function). The sNCT/CPT evaluation is usually prescribed at an affected site(s) and a matched control site(s). The evaluation is not repeated unless there is a clinical suspicion of a deterioration of the patient's sensory condition requiring an objective quantitative neuroselective evaluation. sNCT/CPT studies may also be used to confirm or evaluate a suspected radiculopathy or focal nerve lesion, such as a carpal tunnel syndrome and assist in determining the most appropriate therapeutic intervention. Normal sNCT/CPT evaluation results indicate that no further sNCT/CPT studies are necessary unless a change in the clinical condition suggesting sensory dysfunction warrants an evaluation.
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Neurosurgery
Neurosurgeons use sNCT/CPT studies to monitor return of sensation after a nerve repair. The sNCT/CPT evaluation may be conducted at the skin or mucosal site innervated by repaired or transplanted nerve at approximately three month intervals following surgery to document return of sensation. sNCT/CPT studies are also used to evaluate radiculopathy and compressive neuropathies.
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Occupational Medicine
The CPT evaluation enables the screening and documentation of carpal tunnel syndrome and other repetitive motion disorders resulting in nerve injury, vibration neuropathy, as well as toxic chemical exposure. An additional application is for the assessment of occupationally related lower back injuries. The portability of the CPT device facilitates on-site studies.
CPT Evaluation of Carpal Tunnel Syndrome (CTS):
According to OSHA, repetitive-stress injuries are costing corporate America and the health care industry billions of dollars. Last year, more than 1,200 newspaper and magazine stories highlighted the problem, dozens referring to it as the next great epidemic. Getting the worker back to work, or better yet, keeping the worker on the job requires early detection and effective treatment of Carpal Tunnel Syndrome.
CPT evaluations of median digital nerve integrity, in otherwise healthy individuals, detects and documents hyperesthesia associated with the earliest stages of CTS, as well as the hypoesthesia found in advanced CTS. Abnormal median digital nerve CPT measures, with normal palmar median nerve branch and ulnar nerve digital branch CPT's within a hand, will confirm the diagnosis of CTS. If CTS is detected by CPT evaluation in its earliest stages, it may often be cured by conservative therapy, precluding surgical intervention required to treat advanced CTS. The CPT evaluation enables earlier detection of CTS sensory impairments than the sensory NCV.
The ability of the CPT evaluation to detect sub-clinical measures has yielded the greatest savings for industry, both in financial terms and in medical terms. A recently published study by Jane Vale, M.D. and Ted Dreisinger, Ph.D., involving 983 workers at a Tyson Foods' poultry processing plant, employed the CPT exam as the Quantitative Sensory Test component of a screen for early signs of Upper Extremity Cumulative Trauma Disorder (UECTD). Over a 12 month period, the annual cost of treating these disorders among workers at the plant dropped from $106,000 to $6,000. A follow-up study encompassing 1500 workers using the same protocol yielded similar results.
Presently, there is a great demand for a diagnostic test with the sensitivity of the CPT for reducing the incidence, as well as the medical costs associated with advanced CTS and other types of cumulative trauma disorders.
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Oncology
Oncologists prescribe sNCT/CPT studies to assess the polyneuropathy of cancer and the neurotoxic side-effects of chemotherapeutic agents to assist in developing and modifying treatment plans/goals. A clinical presentation of sensory impairment which requires an objective evaluation for polyneuropathy with testing generally conducted at the great toe test site and a cephalic test site, bilaterally.
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Orthopedic Surgery
Orthopedic surgeons utilize sNCT/CPT studies to assess sensory nerve functional integrity associated with injuries resulting in sensory dysfunction (e.g. radiculopathies and focal/compressive nerve injuries). The sNCT/CPT evaluation is conducted to determine the severity of clinically detected sensory impairments and assist in decisions regarding surgical intervention. A new sNCT/CPT evaluation is only necessary if new sensory impairments develop that require an objective quantitative neuroselective evaluation.
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Pain Management
Patients being treated for chronic pain are administered sNCT/CPT studies when neurologic sensory signs or symptoms require an objective quantitative evaluation for a diagnosis or assessment of therapy. Conditions studied may include spinal cord injuries, polyneuropathies, radiculopathies, focal or compressive nerve lesions. The differential diagnosis of sensory complaints resulting from another etiology, such as soft tissue injury, sprain or strain injury, vascular insufficiency, somatic referred pain or pain of psychogenic origin, must be considered when sNCT test CPT measures are within normal limits. sNCT test results within normal limits do not preclude the necessity for medical care, but are considered when establishing a basis for the differential diagnosis and subsequent treatment plan. The physician evaluating the patient with pain and allodynia who has normal sNCT/CPT evaluation findings may conduct a sNCT Pain Tolerance Threshold (PTT) in order to detect pathology in the sensory nervous system transmission of pain sensation.
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Pharmacology and Toxicology
The utility and sensitivity of the CPT evaluation has resulted in it being utilized by the pharmaceutical and other industries for the past 6 years as a safety device to screen for neurotoxic side effects or exposure effects or to monitor for neuro-protective effects in the clinical evaluation of new pharmaceutical agents for FDA approval.
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Physical Medicine and Rehabilitation
Physiatrists have several uses for sNCT/CPT studies. The studies are used to evaluate suspected sensory impairments based on clinical examination findings and to assist in determining the most appropriate therapeutic intervention. Only one evaluation of the patient is generally required. sNCT/CPT studies may be used to quantify the severity of sensory impairment(s) secondary to brain or spinal cord injuries in rehabilitation patients, or to confirm or evaluate a suspected radiculopathy or focal peripheral nerve lesion to determine the most appropriate therapeutic intervention. sNCT/CPT studies are also utilized to evaluate protective sensation and other sensation in patients to assist in determination of appropriate activities of daily living.
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Physical/Occupational Therapy
The CPT evaluation provides a standardized sensory neurological evaluation that quantifies clinical impressions obtained from a physical examination. CPT testing enables the assessment and monitoring of CNS sensory function following cerebral vascular events and other types of CNS pathology including multiple sclerosis that effect cutaneous sensory function. The CPT examination is also used for disability evaluation and assessing rehabilitation.
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Plastic Reconstructive Surgery
The CPT evaluation allows quantitative assessment of sensory nerve function not possible by the NCT to evaluate cutaneous sensation prior to reconstructive surgery, and provide guidelines for serial or follow-up surgeries. This is presumably because recently reconstructed cutaneous regions are innervated only by small afferent fibers which the sensory NCT can not evaluate.
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Podiatry
Podiatrists perform sNCT/CPT studies to assist in the differential diagnosis and quantitative evaluation of conditions resulting in sensory dysfunction in the foot such as polyneuropathy, radiculopathy, neuroma, focal nerve lesion and tarsal tunnel syndrome. Generally, two to three nerves are tested bilaterally to perform the electrodiagnostic evaluation of the foot. Once the podiatrist has treated the neuropathologic condition causing sensory dysfunction in the foot and the symptoms are resolved, no further sNCT/CPT studies are required for that condition. Podiatrists do not generally treat polyneuropathy or radiculopathy, so additional testing of the foot for these conditions would not be necessary and the patient would instead be referred to the appropriate health care provider.
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Rheumatology
Rheumatologists prescribe sNCT/CPT studies to assess sensory impairments secondary to immunological etiology, in contrast to other causes. (e.g. focal lesions, CTS). Rheumatologists treat apparent sensory dysfunction (e.g. pain limited loss of motion with arthritis) but do not treat focal and most metabolic neuropathies.
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Sports Medicine
The CPT evaluation is used to perform a differential assessment and diagnosis of sensory impairments in sports related injuries.
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Urology
Urologists utilize sNCT/CPT studies to assist in the differential diagnosis of neurogenic impotence. Typically, the ring finger is tested bilaterally and the penis is tested at one or two sites - the glans and the proximal dorsal shaft. Normal sNCT/CPT evaluation results indicate that no further testing is necessary. Recently, urologists have begun to utilize the sNCT/CPT evaluation to evaluate bladder dysfunstion.(1,2)
1. Ukimura, O., Iwata, T., Inaba, M., Honjo, H., Kawauchi, A., Kojima, M.; Miki, T. Quantitative measurement of urinary sensory function assessed by current perception threshold in the bladder using a Neurometer. Neurourology and Urodynamics, Volume 20 (Part 4):124, 2001.
2. Ukimura, O., Miki, T., Kawauchi, A., Iwata, T., Iwata, M., Honjo, H. Preliminary results of quantitative measurement of urinary sensory function assessed by current perception threshold in the bladder. Journal of Urology, Volume 165(5 Suppl.):299, 2001.
