Tinels and Phalens tests

Tests like the Tinels sign and Phalens test may detect median nerve damage. If positive, they are highly suggestive of carpal tunnel syndrome (CTS). The tests are quick and easy to do, and are pain free. Your doctor should be very familiar with them.

But unfortunately, like everything in life,there are trade-offs,in that they are not as accurate or conclusive as the expensive and somewhat painful EMG/ NCS studies.

So,when tested,if your Tinels and Phalens tests are negative it DOESN'T necessarily mean YOU DON'T HAVE CTS.

In fact these tests (Tinels and Phalens) may be negative 50% of the time or more,when the condition (CTS) actually exists!

Read more about TINELS and PHALENS TESTS.

Tinels sign

With the palm up, the examiner taps over the carpal tunnel area of the wrist (where your wrist creases are) 5 or 6 times,using either his finger tip or a reflex hammer.A positive test causes tingling or paresthesia and or sometimes a shock type sensation into the median nerve distribution. See ANATOMY OF THE CARPAL TUNNEL.

The sensation usually goes into the first couple of fingers,but sometimes it can go "backwards" towards the forearm.This is called retrograde conduction.

Phalens test

The examiner bends the patient's wrists downwards about as far as they will go (comfortably) and pushes the backs of the hands together.The patient should hold this position for about one minute.A positive test is indicated by numbness or tingling along the median nerve distribution.Patients sometime describe the feeling as getting a warm tingling feeling.

Some providers record how many seconds it takes before symptoms start (i.e. positive Phalen's to right hand at 15 seconds).This can kind of guage how severe the case of CTS is or it can be used to monitor the progression or lack there of.

Reverse Phalens test (Prayer test)

I sometimes do this test to double-check a patient's findings or if the patient has trouble bending or flexing his wrists inwards, but is able to bend them backwards without too much difficulty.

I have the person touch their palms like they are praying-however, they need to raise their forearms up so that it bends their wrist backwards.(Kind of like The "I Dream of Jeanie" pose).

A positive test is the same as for a regular Phalens test.

In conclusion, although the Tinels and Phalens tests are not the most accurate tests, they are quick and easy to do and are pain free and they are always done as part of a carpal tunnel exam.

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CTS Explanation
Latest diagnostic criteria for CTS
Non-surgical treatments

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