Clinical use of vibratory stimuli to evaluate peripheral nerve injury and compression neuropathy.

The classical approach to evaluating the hand with impaired sensibility is unsatisfactory and frequently incorrect. Since the perception of vibratory stimuli is mediated through the same neural pathways as moving touch, we investigated the clinical use of the tuning fork in 101 patients with peripheral nerve injury and compression neuropathy. In potential nerve lacerations, the preoperative tuning fork evaluations accurately predicted the intraoperative findings: diminished perception of vibratory stimuli correlated with a neural conduction block, due usually to complete nerve division. Furthermore, this study suggests that diminished vibratory perception may be the earliest indication for surgical intervention in the acute compartment syndrome. We concluded that the clinical use of vibratory stimuli to evaluate peripheral nerve injury and compression neuropathy is valid, reliable, expeditious, and a test with high patient acceptability.