Where to place a Rydel-Seiffer tuning fork during a neuropathy examination?

From the Guidelines

The Rydel Seiffer tuning fork should be placed on the dorsal side of the distal phalanx of the first toe during a neuropathy examination. This is based on the guidelines provided by the study 1, which recommends applying the tuning fork on a bony part on the dorsal side of the distal phalanx of the first toe. The study also suggests that the tuning fork should be applied perpendicularly with constant pressure.

When performing the examination, it is essential to follow the guidelines outlined in the study 1, which includes:

• Applying the tuning fork on the patient’s wrists (or elbow or clavicle) initially, so that the patient knows what to expect
• Ensuring the patient cannot see where the examiner applies the tuning fork
• Applying the tuning fork perpendicularly with constant pressure
• Repeating the application twice, but alternating with at least one ‘mock’ application in which the tuning fork is not vibrating

The more recent studies 1, 1, and 1 provide recommendations for assessing diabetic peripheral neuropathy, but they do not specifically address the placement of the Rydel Seiffer tuning fork. However, they do recommend using a 128-Hz tuning fork to assess vibration sensation, which is an essential component of the neuropathy examination.

It is crucial to note that the Rydel Seiffer tuning fork provides standardized measurements that can be tracked over time to monitor progression of neuropathy, making it a valuable tool in the diagnosis and management of neuropathy. The findings from the tuning fork test should be interpreted in the context of other neurological examination findings to ensure accurate diagnosis and effective management of neuropathy.

From the Research

Placement of Rydel Seiffer Tuning Fork

The Rydel Seiffer tuning fork is used to assess vibration sense in patients with neuropathy. The placement of the tuning fork is crucial for accurate assessment.

• The tuning fork can be placed at the following locations:
  • Distal interphalangeal joint of the index finger 2
  • Ulnar styloid process 2, 3
  • Interphalangeal joint of the hallux (great toe) 2, 4
  • Internal malleolus 2
  • Dorsal 1st metatarsophalangeal joint of both sides 5
  • Head of the first metatarsal on the right side 3

Considerations for Placement

• Vibration sense was better perceived in the arms compared with the legs 2
• There was a significant age-related decline of vibration sense at all locations 2
• The sensitivity of the Rydel-Seiffer tuning fork for detecting neuropathy was highest at the hallux 2, 4
• Age and gender should be considered when interpreting the results of the Rydel-Seiffer tuning fork assessment 5