Tinel Sign of the Wrist for Carpal Tunnel Syndrome (CTS)

The Tinel sign is described for various body regions with the aim to evoke symptoms that are characteristic of peripheral nerve entrapment by tapping along the distribution of the affected nerve. Valdes et al. (2013) and Montgomery  (2020) evaluated the Tinel Sign among other tests for Carpal Tunnel Syndrome on its diagnostic accuracy. The results: Positive likelihood ratios from 0.82 to 2.95 and negative likelihood ratios between 0.57 and 0.77 which translates to only a weak clinical value and you are better off using a validated cluster for CTS.

To conduct the test the patient is in sitting position with the forearm and hand placed comfortably on the treatment bench. The examiner then uses two fingers to tap on the median nerve at the wrist.

Some authors recommend tapping along the entire distribution of the median nerve from the index finger to the medial forearm.

The test is considered positive in case tingling in the thumb, index finger, middle finger, and/or medial half of the ring finger are reproduced.

Other orthopedic/neurological tests to assess for carpal tunnel syndrome are:

• Phalen’s Test
• Flick Sign
• Upper Limb Tension Test 1
• Carpal Compression Test
• Hand Elevation Test
• Clinical Prediction Rule of Wainner

Valdes, K., & LaStayo, P. (2013). The value of provocative tests for the wrist and elbow: a literature review. Journal of hand therapy, 26(1), 32-43.

Montgomery, K., Wolff, G., & Boyd, K. U. (2020). Evaluation of the scratch collapse test for carpal and cubital tunnel syndrome—A prospective, blinded study. The Journal of Hand Surgery, 45(6), 512-517.