Wrist & Hand Assessment

Tinel Sign of the Wrist for Carpal Tunnel Syndrome

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Tinel Sign

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 in 2013 and Montgomery in 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.

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References

Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, Holmberg JM, Mahoney K, Hollingsworth DB, Roberts R, Seidman MD. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngology–Head and Neck Surgery. 2017 Mar;156(3_suppl):S1-47.

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