Feb 27 / admin

The Tuning Fork and Fracture Assessment: Myth or Magic?

I was stimulated to write about the use of the tuning fork in osteopathic practice following comments by a colleague, who referred to its use in fracture diagnosis as ‘an urban myth’. However, in spite of this, he did still use the tuning fork in his own practice(albeit in conjunction with auscultation)

The humble tuning fork has been used for many years as a rather ‘low tech’ method of confirming suspicions of the presence of bony fracture.

Although the use of the tuning fork has been questioned by some as it is somewhat lacking in evidence, if shown to be sufficiently reliable, sensitive and specific it would be a very cost effective addition to clinical examination.

There is very limited literature available for review, but a small sampling reveals, for example, a 1997 study using the tuning fork for tibial fracture diagnosis which stated:

The tuning fork test(TFT) is not sensitive enough to rule out a stress fracture on the basis of a negative test. However, in a setting in which there is a moderate to high pretest likelihood of stress fractures, such as military installations with new basic training recruits, it may be reasonable to avoid the cost and delays associated with nuclear imaging by instituting treatment for tibial stress fractures without obtaining a bone scan when the TFT is positive.

A 2005 article concluded, that although it should not be regarded as definitive, a simple tuning fork may assist in diagnosing leg pain in the athlete

a 2006 study in Emergency Medicine also concludes that the tuning fork may be a useful addition to clinical practice.

A well known website aimed at providing a practical resource for General Practitioners also recommends the use of a tuning fork, again with the proviso that a negative test should not be regarded as indicative of the absence of a fracture:

In addition a large scale NHS research project is about to start, indicating a resurgence in interest in the technique.

Obviously more research is still needed, as with many other physical examination procedures. However, when used appropriately, I believe the tuning fork to be potentially useful in practice.

A brief summary of pertinent points:

  • There appears to be consensus on the use of a frequency of 128hz
  • The tuning fork test should not be used as the sole means of diagnosis of a potential fracture, i.e. any competent practitioner will start with a full case history followed by a physical examination and evaluate all of this information before making any conclusions.
  • A negative test may be unreliable but if the test is positive alongside additional factors consistent with possible fracture then the result should not be ignored and within the context of osteopathic practice should be assumed to indicate a possible fracture, triggering appropriate referral.

2 Comments

  1. matt@ osteopath oxford / Sep 10 2012

    I think for something that is important to the patient, we should not be relying on tools or techniques that do not have a definitive outcome.

    • admin / Sep 10 2012

      Hi Matt
      Thanks for the comment. In reply I would agree that it would be wrong to ‘rely’ on the tuning fork as a method of determining if a fracture was likely, however, the discussion was prompted by the idea that new research seems to suggest that the tuning fork might still have a role in clinical diagnosis alongside a thorough case history and detailed examination. It is of course a very low tech and simple piece of equipment, but one which might be very convenient to use when confirming or adding to the suspicion of the presence of fracture prior to referral.
      On another note I would be keen to know which tools or techniques (available to osteopaths) you regard as having a definitive outcome?

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