Phalen’s Test for Carpal Tunnel Syndrome

Traditionally, stand-alone tests have no added value compared to a thorough history in the diagnostic process of carpal tunnel syndrome. Phalen’s test was also excluded in a clinical prediction rule of Wainner as its predictive ability was too low. You can find a video on the CPR of Wainner in the top right corner. Furthermore, Valdes et al from 2013 report a positive likelihood ratio of 2.68 and a negative likelihood ratio of 0.54 for the test which renders its clinical value rather weak.

To conduct the test, the patient is in standing or sitting position and is asked to maximally flex both wrists while pressing the dorsal side of both hands against each other and to hold this position for one minute.

In a positive test, the patient’s paresthesia in the distribution of the median nerve will be reproduced, namely tingling in the thumb, index, and middle finger and/or the medial half of the ring finger.

Other common tests to assess Carpal Tunnel Syndrome are:

• Tinel’s Sign at the Wrist
• Flick Sign
• Clinical Prediction Rule for CTS
• Carpal Compression Test
• Upper Limb Neurodynamic Test 1 (ULTT1)
• Hand Elevation Test

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

Wainner RS, Fritz JM, Irrgang JJ, Delitto A, Allison S, Boninger ML. Development of a clinical prediction rule for the diagnosis of carpal tunnel syndrome. Archives of Physical Medicine and Rehabilitation. 2005 Apr 1;86(4):609-18.