Vibration sense:

Use a low pitched tuning fork (128Hz: the longest one).

1. Test with a non-vibrating tuning fork first to ensure that the patient is responding to the correct stimulus.
2. Place the stem of the fork over the distal interphalangeal joint of the patient's index finger.
3. Ask the patient to tell you if they feel the vibration.

If vibration sense is impaired proceed proximally:

1. Wrists
2. Elbows
3. Clavicles

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