Sensory: Exam Demonstration

Upper extremity vibration and proprioception

Vibration is tested by sensation of a tuning fork held on a bony prominence.  Testing should be done initially distally.  If there is decreased sensation distally, testing should also be done in other distal locations, as well as more proximally, to determine the extent of the deficit.

Proprioception in fingers is tested by determining if the patient (with eyes closed) can sense whether a finger is being moved up or down.  If there is a deficit when testing a finger, testing of hand or forearm proprioception should be conducted to determine the extent of the deficit.

Vibration and proprioception sensations are mediated by the dorsal column / medial lemniscus pathway. This pathway ascends ipsilaterally in the dorsal column to the gracile and cuneate nuclei in the medulla; fibers then cross the midline and enter the medial lemniscus to ascend to the thalamus, and then to the somatosensory cortex.

Vibration sense is often the first sensation lost in peripheral neuropathy.  Since distal deficits appear first in most peripheral neuropathies, comparing proximal to distal sensation can help determine the location and extent of a lesion. 

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