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 Review of Clinical Signs

Tinel’s Sign and Phalen’s Test

Series Editor and Author: Frank L. Urbano, MD

1. Tinel’s sign should be present in all of the following conditions EXCEPT:
  1. Tarsal tunnel syndrome
  2. Carpal tunnel syndrome
  3. Thoracic outlet syndrome
  4. Diabetic neuropathy
  5. Cubital tunnel syndrome
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2. Which one of the following statements about Tinel’s sign is true?

  1. Tinel’s sign is often painful.
  2. To elicit Tinel’s sign, the examiner applies very firm pressure over the median nerve, using a reflex hammer to tap the nerve quite hard.
  3. Tinel’s sign may be caused by an abnormally excitable nerve cell membrane.
  4. Tinel’s sign is pathognomonic for carpal tunnel syndrome.
  5. The correlation between Tinel’s sign and electrodiagnostic testing in the diagnosis of carpal tunnel syndrome is excellent.
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  1. Phalen’s test is positive if the patient experiences paresthesiae after the wrist is held in full flexion for 1 minute.
  2. Individuals without carpal tunnel syndrome will develop a positive Phalen’s test if wrists are held in full flexion for 3 minutes or longer.
  3. When performing the test, the patient’s hand should be forced into flexion.
  4. A positive Phalen’s test is caused by local hypoxia resulting from pressure on the radial artery in the wrist.
  5. Phalen’s test is generally less diagnostic of carpal tunnel syndrome than Tinel’s sign.
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