Physical examination maneuver
Physical Exam
Vibratory Sensation
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Video coming September 2026
How to Perform
With the patient’s eyes closed, strike a 128-Hz tuning fork and place its base firmly on the area being tested, preferably over a bony prominence. Ask whether they feel the vibration and have them report when it stops. At unpredictable intervals, damp the fork while it remains in place to confirm that the patient can distinguish vibration from pressure alone. Compare the same area on the opposite side.
How to Interpret
Showing all 3 findings
Carpal Tunnel Syndrome
Abnormal vibration sensation in the hand
Rule in
InconclusiveWide CI
Rule out
Not helpfulWide CI
Evidence:Strong
Peripheral Neuropathy
Lower-extremity bedside cluster positive (≥2 of 3: Achilles reflex absent despite facilitation, vibration <10 seconds at toe with 128-Hz tuning fork, or position sense <8 of 10 1-cm trials at toe)
Rule in
HelpfulDerived CI
Rule out
Very helpfulDerived CI
Evidence:Limited
Reduced vibratory perception at the great toe
Rule in
Very helpfulNo CI
Rule out
Somewhat helpfulNo CI
Evidence:LimitedResearch in progress