So it's not a useful test for hand SFN?

Hi Bowtie,

I have small nerve fiber polyneuropathy, confirmed by skin biopsy on my right leg. Left leg is now affected as well. Pain in my hands, especially the palms, appeared after my leg symptoms. My Neurologist explained that it typically presents in feet first and then progresses up from there to legs and hands. That is why the skin biopsy is taken from the leg. But she said typically......There are exceptions to this I am sure, where hands/arms come first. Sorry, my experience may not be helpful to you.
Would love to hear back from you if you learn an answer to your specific question! Thanks!

Thanks for your reply.

The neurologist first balked, but then decided it could be done for the hands.


I have to wait until the end of July, but will report back with my results.

Yes, it can be done on the hands, etc.

--on the upper limbs, a sample is taken from the back of the upper arm just above the elbow, as that is one of the locations for which a database of "normed" values has been obtained over years of research.

Dr took samples about 4" above wrist on forearm and below calf on leg


Still awaiting results

Dr said there was no standard for the hand and the forearm standard is fairly new.

He called my results "mild small fiber idiopathic neuropathy"

I asked my neurologist why he only did samples from my lower leg and hip area. I have neuropathy in my arms and legs. He said that the normal values (all the studies that have been done) focused on samples from legs (since it is more common and is more often the first location for presenting symptoms of peripheral neuropathy). It's the same with blood pressure, and all other readings that are done. The "normal values" are drawn from conclusive evidenced based medicine/studies. So whatever populations they studied or locations they performed a test on, that's more "standardized" and interpretable.

Hope that helps!
-J