DETERMINATIONtory appreciation by application of the stem of a tuning fork to the bony prominences of the body is part of the routine neurologic examination.
The anatomic pathways for vibratory conduction are described as running from receptor endings in the tendons and muscles through the deep nerves to the posterior roots, to the posterior columns of the ipsilateral side to the nuclei of Goll and Burdach, then across to the median fillet and up to the thalamus and fanwise to the postcentral cortex. Wechsler 1 stated:
Vibratory sensation is conveyed up to the thalamus practically by the same tracts as joint sensibility (both representing deep or proprioceptive sensation) and, except for cortical lesions, is lost at the same time with it. Only occasionally does one observe dissociation between them. Both have the same significance in peripheral nerve disease, tabes, and other cord affections. It is not sound but a vibratory
GOLDBLATT S. PALLHYPESTHESIA: Depression of the Appreciation of Vibration in Trauma and in Disease; a Preliminary Report. Arch NeurPsych. 1948;59(3):292–301. doi:10.1001/archneurpsyc.1948.02300380021002
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