Abstract
Objective
To establish the validity of bedside sudomotor tests in a controlled prospective study.
Methods
Five different tests were used to assess presence of sweating at seven bilaterally symmetrical body loci, namely, examination with the unaided eye, visualization with light reflection, magnification with an ophthalmoscope, palpation of skin for slickness, and gliding the back of a spoon over the skin to detect friction. Sensitivity and specificity of these bedside tests were compared with the thermoregulatory sweat test in 130 subjects with generalized body sweating and 16 patients with complete anhidrosis.
Results
The spoon test was more sensitive in detecting sweating than the other four bedside tests, demonstrating sensitivity of about 86% at the neck, 58% at the chest, and 51% at the forehead. Specificity of the spoon test was almost 100% at all body sites except at the chest (81%) and the neck (50%).
Interpretation
With caveats related to methodology, the spoon test is a clinically practical and useful bedside screening test for the assessment of sweating, especially at the forehead and chest.
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References
Bors E (1964) Simple methods of examination in paraplegia: I. The spoon test. Paraplegia 2:17–19. doi:10.1038/sc.1964.4
Cheshire WP Jr, Kuntz NL (2008) Clinical autonomic disorders. In: Low PA, Benarroch EE (eds) Clinical evaluation of the patient with an autonomic disorders, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 112–129
Guttmann L (1947) The management of the quinizarin sweat test (Q.S.T.). Postgrad Med J 23:353–366
Illigens BM, Gibbons CH (2009) Sweat testing to evaluate autonomic function. Clin Auton Res 19:79–87. doi:10.1007/s10286-008-0506-8
Khurana RK (2002) Dysautonomia. In: Schuster MM, Crowell MD, Koch KL (eds) Schuster atlas of gastrointestinal motility. BC Decker Inc, Hamilton, pp 335–351
Fealey RD (2008) Clinical Autonomic Disorders. In: Low PA, Benarroch EE (eds) Thermoregulatory sweat test, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 244–263
Weiner JS (1945) The regional distribution of sweating. J Physiol 104:32–40
Kahn EA (1951) Direct observation of sweating in peripheral nerve lesions; its use as a simple diagnostic test. Surg Gynecol Obstet 92:22–26
Sakuma TH, Maibach HI (2012) Oily skin: an overview. Skin Pharmacol Physiol 25:227–235. doi:10.1159/000338978
Tsementzis SA, Hitchcock ER (1985) The spoon test: a simple bedside test for assessing sudomotor autonomic failure. J Neurol Neurosurg Psychiatry 48:378–380
Rosenberg ML (1989) The friction sweat test as a new method for detecting facial anhidrosis in patients with Horner’s syndrome. Am J Ophthalmol 108:443–447
Low PA, Caskey PE, Tuck RR et al (1983) Quantitative sudomotor axon reflex test in normal and neuropathic subjects. Ann Neurol 14:573–580. doi:10.1002/ana.410140513
Acknowledgments
We thank Eshetu Tefera, MS, of MedStar Health Research Institute for statistical analysis and Lyn Camire, MA, ELS, of our department for editorial support.
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The authors report no potential conflict of interest in connection with this study.
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Khurana, R.K., Russell, C. The spoon test: a valid and reliable bedside test to assess sudomotor function. Clin Auton Res 27, 91–95 (2017). https://doi.org/10.1007/s10286-017-0401-2
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DOI: https://doi.org/10.1007/s10286-017-0401-2