Clinical Name for Vibration Sensation in the Skin
The clinical term for vibration sensation in the skin is "pallesthesia" or "vibration sense," which is formally assessed using a 128-Hz tuning fork placed on bony prominences as part of the neurological examination. 1
Clinical Assessment of Vibration Sensation
Vibration perception testing is a standardized component of peripheral neuropathy screening, particularly for diabetic patients, where it serves as one of the primary diagnostic modalities. 1 The test involves:
- Placement of a 128-Hz tuning fork on the dorsal aspect of the hallux (great toe) or other bony prominences 1
- Assessment follows a distal-to-proximal pattern on both sides until threshold is detected 1
- This test should be combined with at least one other sensory test (10-g monofilament, pinprick, temperature, or ankle reflexes) for comprehensive evaluation 1
Clinical Significance
Loss of vibration sensation (pallesthesia) has high diagnostic value, with 70% sensitivity and 90% specificity for detecting severe neuropathy, and identifies patients at high risk for foot ulceration and amputation. 2 The American Diabetes Association recommends annual screening starting at type 2 diabetes diagnosis or 5 years after type 1 diabetes diagnosis. 1, 2
Abnormal Vibration Sensations (Paresthesias)
When patients experience abnormal vibration sensations rather than loss of sensation, this represents paresthesias—ectopic impulse activity in cutaneous afferents. 3 These can be induced by:
- Hyperventilation (alkaline shift increasing persistent Na+ conductance) 3
- Ischemia (membrane depolarization affecting Na+ channels) 3
- Release of ischemia or prolonged tetanization 3
Occupational Vibration Exposure
Vibration syndrome is a distinct clinical entity affecting workers using hand-held vibratory tools, characterized by tingling, numbness, or blanching of fingertips (vibration-induced white finger). 4 This differs from neurological vibration testing and represents pathological exposure to mechanical vibration. 5, 4
Critical Diagnostic Pitfall
Vibration testing alone is insufficient to rule out loss of protective sensation—at least two normal sensory tests are required for adequate screening. 2 Band-like vibration sensations at a specific dermatomal level indicate spinal cord pathology rather than peripheral nerve disease and require urgent imaging if accompanied by progressive weakness, bowel/bladder dysfunction, or gait disturbance. 2, 6