Flick Sign | Carpal Tunnel Syndrome | Wrist & Hand Assessment

We have covered several tests for Carpal Tunnel Syndrome as well as its differential diagnosis here on our website. Most of the individual provocation tests only yield weak diagnostic accuracy and the best available tools we have is a thorough patient history and clustered findings such as those proposed by Wainner et al. (2005).  Wainner also included the flick sign in their clinical prediction rule so let’s look at its individual validity in detail.
A systematic review by D’Arcy et al. (2000) references diagnostic accuracy findings of the original proponent of the Flick sign, which was Pryse-Phillips in the year 1984. In the original study, the Flick sign yielded a sensitivity of 93% and specificity of 96%. These findings have been critiqued by colleagues who were not able to reproduce them in similar study designs shortly after the original publication. In 2004, Hansen and colleagues re-evaluated the flick sign in their diagnostic accuracy study and also found a sensitivity of 37% and specificity of 74% thus echoing the overall weak clinical value of the flick sign in the diagnosis of Carpal Tunnel Syndrome.

The flick sign is more of a patient history finding than it is a special test. Essentially, you want to know whether the patient flicks the affected hand in order to ease symptoms such as pain and paresthesia. Imagine a hand motion such as when shaking down a thermometer.

Shaking the hand and wrist should reduce symptoms of carpal tunnel syndrome in order for the flick sign to be present or positive.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other common tests to assess Carpal Tunnel Syndrome are:

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

References

D’Arcy, C. A., & McGee, S. (2000). Does this patient have carpal tunnel syndrome?. Jama, 283(23), 3110-3117.

Hansen, P. A., Micklesen, P., & Robinson, L. R. (2004). Clinical utility of the flick maneuver in diagnosing carpal tunnel syndrome. American journal of physical medicine & rehabilitation, 83(5), 363-367.

Krendel, D. A., Jöbsis, M., Gaskell Jr, P. C., & Sanders, D. B. (1986). The flick sign in carpal tunnel syndrome. Journal of Neurology, Neurosurgery, and Psychiatry, 49(2), 220.

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.