Abstract
Referrals to evaluate distal pain, numbness, and tingling are one of the more common questions posed to me in the neuromuscular clinic and EMG laboratory. The spectrum of causes of peripheral nerve disease is very broad and the diagnostic challenge can be daunting. The organization of this issue of Seminars of Neurology reflects the framework that I have found to be rational and efficient. Rational in that I follow an algorithm during the history and examination that leads to a full understanding of the features and a reasonable set of laboratory tests. This approach has proven to be both efficient and effective with a high probability of reaching a diagnosis. It must be appreciated that despite an extensive search for causes, a significant percentage of peripheral neuropathies remain idiopathic or cryptogenic. Further, when a specific diagnosis is reached it usually emerges early in the investigation, and when a diagnosis does not emerge, a broad fish net search rarely nets an unsuspected diagnosis.
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