Stocking-Glove Pattern Definition
The stocking-glove pattern is a symmetric, length-dependent distribution of sensory symptoms that begins distally in the toes and fingers and progresses proximally as the neuropathy worsens, reflecting the fact that the longest nerve axons are affected first.
Clinical Presentation
The pattern manifests as:
- Distal onset: Symptoms start in the toes first, then fingers 1
- Symmetric distribution: Both sides of the body are affected equally 2
- Proximal progression: As the condition worsens, symptoms advance up the legs (like pulling on stockings) and up the arms (like pulling on gloves) 3
- Length-dependent: The longest nerve fibers are damaged first, which is why feet are affected before hands 1
Typical Symptoms in This Distribution
"Plus" Symptoms (Positive Sensory Features)
- Numbness and tingling 3
- Burning sensations 1
- Pins and needles (paresthesias) 1
- Pain (often worse at night) 4
- Dysesthesia, allodynia, and hyperalgesia 1
"Minus" Symptoms (Sensory Loss)
- Impaired light touch perception 1
- Reduced vibration sense 1
- Decreased pin prick sensation (hypoalgesia) 1
- Loss of proprioception 1
Clinical Examination Findings
Assessment should document sensory deficits in this characteristic distribution using 4:
- Small fiber function: Pinprick and temperature (especially cold) sensation
- Large fiber function: Vibration perception with 128-Hz tuning fork, proprioception, light touch with 10-g monofilament, and ankle reflexes
Common Causes
This pattern is characteristic of:
- Chemotherapy-induced peripheral neuropathy (platinum drugs, taxanes, vinca alkaloids, bortezomib) 3, 2
- Diabetic peripheral neuropathy (most common cause worldwide) 4, 5, 6
- Toxic neuropathies (alcohol, medications) 5
- Metabolic neuropathies (vitamin B12 deficiency) 5
Key Clinical Pitfall
The stocking-glove pattern is predominantly sensory rather than motor 3, 2. If significant motor involvement or asymmetry is present, consider alternative diagnoses such as radiculopathy, plexopathy, or other non-length-dependent neuropathies 1.