We are excited to report the results of recently published research article utilizing the ETF. This study by Raymond et al. from the Journal of Diabetes Science and Technology has recommended the ETF as the best choice of vibration testing instruments to pair with Semmes-Weinstein monofilament testing when performing lower extremity sensation testing in diabetic patients. This study protocol compared the ETF to the traditional 128 Hz tuning fork and biothesiometer in terms of ease of use, testing time and standardization of vibration output. The authors recommended the ETF over the other devices. We welcome the results of this study and look forward to more research papers validating the clinical use of the ETF.
In our research into emerging uses for tuning forks, we came across an interesting study by Kothari et al. In their article, they hypothesized that improved timing of post-operative analgesics could be achieved by assessing the return of vibration perception. Specifically, they studied 60 male patients who had undergone inguinal herniorrhaphy under subarachnoid block. Patients were evenly divided into control and experimental groups. The experimental group was given medication upon return of vibration sense, controls were given their doses after complaining of pain. All patients had vibration testing performed at the anterior superior iliac spine (ASIS) reasoning that this large nerve fiber function would precede the recovery of small nerve fibers responsible for pain sensation. They suggested that optimal timing of analgesic administration could be achieved by monitoring the return of vibration perception thereby reducing patient pain and the need for additional pain medication.
The results of this study were promising as Kothari noted in their discussion: “…we conclude that if analgesic is given with the return of vibration sense as compared to actual return of subjective pain at the surgical site, then not only patient compliance is better (low VAS Score) but the respiratory and haemodynamic parameters also remain stable.”
Although this technique has not yet gained widespread popularity, it could develop into a helpful method of improving pain relief following surgery in the future.
Anesthesiologists have long observed that surgical anesthetic blocks tend to progress from smaller to larger diameter nerves. This onset of blockade results in a progressive loss of temperature (cold before hot), pain, light and deep touch, vibration and proprioception. Restoration of these sensations usually occurs in reverse order as patients recover from a block.
128 Hz tuning forks have been used as a simple method of assessing vibration perception in patients undergoing surgical anesthesia. Tuning forks have proven useful as vibration perception is often one of the last sensations to be lost and one of the first to be regained. Vibration recovery is especially useful as it is associated with a return of motor function. This was highlighted in a study by Schulz-Stubner et al. In their study, they were able to correlate a return to baseline vibration sense with recovery from motor blockade after epidural anesthesia. They concluded that a return of vibration perception to baseline was a valid method of documenting recovery prior to discharge after surgery.
In another more recent study by Jindal et al, the onset of sensory and motor blockade after brachial plexus block was assessed with a 128 Hz Rydel-Seiffer tuning fork and manual motor testing. The decision to use the Rydel-Seiffer instead of the traditional tuning fork was made based on its quantitative output. Jindal determined that vibration sense was a valid indicator for the onset of surgical anesthesia after brachial plexus block. They further advocated for the use of the Rydel-Seiffer tuning fork along with motor testing as objective tools for assessing onset of surgical anesthesia after brachial plexus block.
These studies may signal a new role for quantitative vibration testing in the assessment of surgical anesthesia patients. Instruments like the Rydel-Seiffer tuning fork and the ETF128 are well-suited to this task due to their quantitative output and reliability. Given the results presented by Schulz-Stubner and Jindal, tuning fork testing could become the new standard for evaluating onset and recovery from surgical anesthesia.
A 39 year old female presented complaining of pain at the 3rd interspace of the right foot of a one year duration. She denied trauma or other initiating events leading to her foot pain. She noted sharp, intermittent pain aggravated by all closed shoes. She used acetominophen for pain relief with limited results.
Physical exam revealed pain on dorsal to plantar compression of the 3rd interpace right foot which was sharp in nature. ETF128 timed vibration test(TVT) was 7.8s on the 4th digit right, 13.5s on the 4th digit left confirming neurological deficit on the right.
*ETF clinical cases are presented to demonstrate the diagnostic utility of the ETF128. Cases are derived from actual ETF customer practices. Customers are encouraged to submit their own cases for future posts.
Last week, The World Health Organization (WHO) released its Global Report on Diabetes. This sobering document cited a nearly 400% increase in the know cases of diabetes since 1980. The estimated number of patients with diabetes now stands at a staggering 422 million. In light of these findings, WHO has urged a renewed focus on prevention and management of diabetes and its complications including lower limb infections and amputations.
As the cited throughout the medical literature, the incidence of diabetic peripheral neuropathy (DPN) among diabetic patients is at least 50%. This translates into over 200 million diabetic patients with DPN globally. This is particularly troubling as DPN is the leading precursor of diabetic foot complications. Given these startling statistics, it is more important than ever to accurately diagnose and track the progression of DPN in this patient population.
The ETF128 is ideally suited to assist medical professionals in this daunting task. This simple yet sophisticated instrument can provide early detection of DPN and quantitative documentation enabling tracking over time. Additionally, its ergonomic design and portability make it a truly point-of-care instrument easily incorporated into any clinical exam.