Semmes-Weinstein Monofilaments ,  Clear Vision Reveals^™,  Low Temperature Thermoplastic

Timely Neuropathy Testing

TNT1st^™  SEMMES-WEINSTEIN COLOR MONOFILAMENTS^™

ORIGINAL HANDLE STYLE

CLASSIC HAND AND BODY MONITORING SET

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 5 filament set only  $73.99 sale$59.99

 6 filament set only  $88.99 sale$69.99

                                                                             ... in durable box                

  

A classic rod handle set incorporating the original Semmes-Weinstein
style in the original 5 monofilament Bell-Krotoski Mini Kit designed to
include the most important monofilaments for hand or body screen,
monitoring, or mapping, and a sixth monofilament at the 10 gram level
to make one set suitable for monitoring both the hands and feet. 
 

Many hand therapists as well as pedorthotists have requested an
additional monofilament between the 4 gram and 300 gram levels
traditionally used for the upper extremity since the Mini Kit reduced
version of the long set was created in 1978.   Monofilaments in our set 
are color-coded and now consists of all of the most useful and frequently
needed monofilaments for screening and monitoring the hands and feet,
as well as the rest of the body, including the face. For normative
threshold  studies, inclusion of the lighter monofilaments  included in
original 20 monofilament set are recommended.  If these are needed
contact us for source information.

Monofilament sizes included in the screen and monitoring set with instructions:

1) The green 2.83 [within normal limits 50 milligram level*] found in studies to be "within normal limits" for the hand, dorsum of foot and rest of body.

2)  The blue 3.61 [diminished light touch 200 milligram level*]  found in studies to be "within normal limits" for the plantar foot.  

[For early detection of peripheral nerve neuropathy (change from normal threshold) and monitoring of neuropathy (worsening or improvement of sensibility) studies need to include normal threshold monofilaments for hands and feet.  The level of detection for normal subjects on the plantar surface of the foot was originally established by Weinstein, co-inventer and original author of the nylon monofilament test, to be at the 200 milligrams level (several orders of magnitude lighter than 10 grams, and even lighter than 1 gram.).  This 200 milligram normal threshold level for the plantar surface of the foot has been confirmed more recently by multicenter studies. The foot plantar surface (sole) instep, underneath toes, and even entire surface for some individuals is at the 2.83 50 milligram level.  This is useful information for those assessing the exact status of a particular nerve. In non- shoe wearing populations,  a degree  of callus can mask normal threshold detection, and the instep and underneath toe area can help define the actual nerve status. Foot screen monitoring sites are usually only on the contact area of he foot.] 

3) The purple 4.31 [diminished protective sensation 2 gram level*]  "protective" monofilament to identify diminished but still  present protective sensation any place on the body, 

4) The red 4.56 [loss of protective sensation 4 gram level*] monofilament to identify "loss of  protective sensation" on the hand and rest of the body including the dorsum of the foot. (This is the original loss of protective sensation level, and is increasingly being used for detecting peripheral neuropathy in the foot).

5) The orange 5.07 [protective sensation for plantar foot 10 gram level*] monofilament commonly used to identify protective or loss of protective sensation in patients are at risk of ulcers and amputations on the plantar surface of the foot where there is often more callus. 

[The 5.07 marking number (index) monofilament 10 gram level monofilament is the closest filament to 10 grams in the original  set of 20 monofilaments. This is the monofilament size used in foot program studies at the National Hansen's Disease  Center, Carville, LA.  Its force was simply rounded to be understood for professional and untrained  health care workers who were taught foot screens. Those who adjust or cut off this standard size monofilament to achieve an  exact 10 gram force of application then run the risk of producing a heavier monofilament than was used in the studies  that originally defined this force. Some even consider even the  5.07 monofilament to be too heavy for detection of "loss of protective sensation " on the plantar surface of the foot. It is also important to identify patients with earlier more responsive to direct treatment for the nerve condition as well as those patients with blisters and ulcers. In studies previous to the monofilament application in the foot in a specific foot program, the threshold for "loss of protection" on the foot was determined to be in the order of 4 grams, with 2 grams being protective  as determined for the hands and rest of the body. Earlier detection of those at risk can possibly result in improved treatment and protection for the nerve before there is permanent and irreversible damage.  Still the 10 gram level monofilament has become widely  accepted and is a useful aide in having patients actually inspect their feet, and  recognize a severe loss of  protective sensation where they are at risk of ulcers and amputations.]

6)  The  light red 6.65 "residual deep pressure" 300 gram level] monofilament to identify when a nerve has lost useful nerve sensory function.  This monofilament is also used to identify a patient who after nerve loss or repair first responds and indicates some return in nerve function  before lighter monofilaments are detected.

Key Benefits

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References:
Bell JA: "Sensibility Testing" , In Hunter JM, Schneider LH, Mackin EJ, and Bell JA (eds), Rehabilitation of the Hand, Philadelphia, CV Mosby:269-291, 1978

Bell-Krotoski JA: "Sensibility Testing; Current Concepts", In Hunter JM, Mackin EJ, Callahan AD (eds), Rehabilitation of the Hand, 4^th ed, Philadelphia, CV Mosby:109-128, 1995.

Bell-Krotoski JA, Fess EE, Hiltz D, Figarola J: "Threshold Detection and Semmes Weinstein Monofilaments: A Comparative Study", J Hand Ther, 8:155-162, 1995.

Semmes J, Weinstein S, Ghent l, Teuber HL:"Somatosensory Changes After Penetrating Brain Wounds in Man", Cambridge, Mass, 1960, Harvard University Press.

Weinstein S: "Intensive and Extensive Aspects of Tactile Sensitivity as a Function of Body Part, Sex, and Laterality", in Kenshalo’s The Skin Senses.

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Last modified: May 20, 2008