Upper Limb Neuro
 

Vibration Sense

 
 
Bookmark

Overview

  • Also known as pallesthesia
    • How to Assess

    • With the patient's eyes closed, place a vibrating 128hz tuning fork over the interphalangeal joint of the great toe. Ask the patient to describe the sensation. If they can feel it vibrating, progressively diminish the vibration until they cannot feel it. If they cannot feel it vibrating, test on the medial / lateral malleolus and then the tibial tuberosity.
  • This test is best performed on skin overlying bone rather than soft tissue.
    • Causes of Isolated Vibration and Proprioceptive Loss

    • Demyelination - proprioceptive and vibration fibres are myelinated while pain sensation fibres are not.
    • Brainstem lesions involving the medial lemniscus
    • Dorsal spinal artery occlusion (unilateral impairment)

Dorsal Column Pathway

  • Cortical Centre
    Primary sensory cortex (postcentral gyrus)
     
     
    3rd Order Nuclei
    Ventral posterolateral (VPL) nucleus of thalamus
     
     
    Central Pathway
    Medial lemniscus
    Decussation
    Medulla
     
    2nd Order Nuclei
    Lower medulla - nucleus cuneatus (UL) / gracilis (LL)
     
     
    Spinal Pathway
    Dorsal column - fasciculus cuneatus (UL) / gracilis (LL)
     
    1st Order Nuclei
    Dorsal root ganglion
     
     
    Receptors
    Pacinian corpuscles / Merkel disc receptors / Meisner's corpuscles (vibration)
    Neuromuscular spindles (proprioception)

Overview

    • Note

      Vibration sense is mediated by
    • Merkel disc receptors (low frequencies 5-15 Hz)
    • Meissner’s corpuscles (mid frequencies 20-50 Hz)
    • Pacinian corpuscles (high frequencies 60-400 Hz)
  • Therefore clinical testing of vibration is mediated by pacinian corpuscles.
Last updated on January 1st, 2017
 
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Want more info like this?
  • Your electronic clinical medicine handbook
  • Guides to help pass your exams
  • Tools every medical student needs
  • Quick diagrams to have the answers, fast
  • Quizzes to test your knowledge
Explore
   
 
 

Read More...

 Bumbasirevic M, Palibrk T, Lesic A, Atkinson HD. Radial nerve palsy. EFORT open reviews. 2016 Aug;1(8):286-94.
Chang IT, DePold Hohler A. Bilateral radial nerve compression (crutch palsy): A case report. Journal of Neurology & Neurophysiology. 2012;3(3):10-1.
 Deuschl G, Wenzelburger R, Löffler K, Raethjen J, Stolze H. Essential tremor and cerebellar dysfunction clinical and kinematic analysis of intention tremor. Brain : a journal of neurology. 2000;123 ( Pt 8):1568-1580. Dichgans J. Clinical Symptoms of Cerebellar Dysfunction and their Topodiagnostical Significance. Human Neurobiology. 1984; 2(4): 269-279. Florman JE, Duffau H, Rughani AI. Lower motor neuron findings after upper motor neuron injury: insights from postoperative supplementary motor area syndrome. Frontiers in Human Neuroscience. 2013 March; 7(85): 1-7. Gilman S. Joint position sense and vibration sense: anatomical organisation and assessment. J Neurol Neurosurg Psychiatr. 2002;73:473-477. Gonzalez-Alegre P, Recober A, Kelkar P. Idiopathic brachial neuritis. The Iowa orthopaedic journal. 2002;22:81. Ilg W, Golla H, Thier P, Giese M. Specific Influences of Cerebellar Dysfunctions in Gait. Brain. 2007 March; 130(3): 786-798.
Johnson EO, Soucacos PN. Proprioception. International Encyclopedia of Rehabilitation. 2010.
Katz JN, Simmons BP. Carpal tunnel syndrome. New England Journal of Medicine. 2002 Jun 6;346(23):1807-12.
 Kelley MJ, Kane TE, Leggin BG. Spinal accessory nerve palsy: associated signs and symptoms. journal of orthopaedic & sports physical therapy. 2008 Feb;38(2):78-86. Khadilkar SV, Khade SS. Brachial plexopathy. Annals of Indian Academy of Neurology. 2013 Jan;16(1):12. Love S. Demyelinating diseases. Journal of Clinical Pathology. 2006;59(11):1151-1159. doi:10.1136/jcp.2005.031195. Neal SL, Fields KB. Peripheral nerve entrapment and injury in the upper extremity. American family physician. 2010 Jan 15;81(2). Pattanshetty RB, Gaude GS. Critical illness myopathy and polyneuropathy - A challenge for physiotherapists in the intensive care units. Indian Journal of Critical Care Medicine. 2011;15(2): 78-81. Pedroso JL, Barsottini OG, Goetz CG. Babinski's contributions to cerebellar symptomatology: building the basis of the neurological examination. Arq Neuropsiquiatr. 2013 Dec; 71(12): 973-5. Poncelet AN. An algorithm for the evaluation of peripheral neuropathy. Am Fam Physician. 1998; 57: 755. Rezania K, Roos RP. Spinal Cord: Motor Neuron Diseases. Neurologic Clinics. 2013 Jan; 31(1): 219-239. Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV. Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. The Journal of bone and joint surgery. British volume. 2005 Dec;87(12):1647-52. Sharshar T, Citerio G, Andrews PJ, Chieregato A, Latronico N, Menon DK, Puybasset L, Sandroni C, Stevens RD. Neurological examination of critically ill patients: a pragmatic approach. Report of an ESICM expert panel. Intensive Care Med. 2014 Feb. Sosa RG, Blackburn J. Identifying Common Movement Disorders in the Emergency Department. Clinical Pediatric Emergency Medicine. 2015;16:55-61.
Spinner RJ, Poliakoff MB, Tiel RL. The origin of “Saturday night palsy”?. Neurosurgery. 2002 Sep 1;51(3):737-41.
 Sullivan SJ, Hammond-Tooke GD, Schneiders AG, Gray AR, McCrory P. The Diagnostic Accuracy of Selected Neurological Tests. Journal of Clinical Neurology. 2012; 19(3): 423-427 Sutaria RB. Mononeuritis Multiplex. InMusculoskeletal Sports and Spine Disorders 2017; 239-241 Walsworth MK, Mills III JT, Michener LA. Diagnosing suprascapular neuropathy in patients with shoulder dysfunction: a report of 5 cases. Physical therapy. 2004 Apr 1;84(4):359-72. Warburton KL, Wakerley B. Dermatological Clues to Neurological Diagnoses. Practical Neurology. 2011; 11: 289-295. Wiater JM, Flatow EL. Long thoracic nerve injury. Clinical orthopaedics and related research. 1999 Nov(368):17-27. Willison HJ, Winer JB. Clinical evaluation and investigation of neuropathy. J Neurol Neurosurg Psychiatr. 2003;74 Suppl 2:ii3-8.
Feedback