Tinels Test
Other Names
- Tinels Test
- Tinel Sign
- Tinel’s Test
- Hoffman-Tinel sign
- Tinel's Sign for Brachial Plexus Test
Purpose
- Used to evaluate nerves as an etiology of patients symptoms
- Most commonly used to evaluate for carpal tunnel syndrome
- Can be used on many peripheral nerves
Upper Extremity
- Tap reflex hammer over the supraclavicular fossa
- Positive test
- Tingling/paresthesia down the arm
- Patient is seated, elbow flexed and forearm supinated
- Examiner holds patients affected wrist in hand
- The examiner gently taps finger over area of flexor retinaculum on the median nerve
- Continue percussing and move up towards the palmar creases.
- Return back to the flexor retinaculum
- Positive test:
- Reproduction of the patients symptoms (pain, numbness, tingling)
- The ulnar nerve can be compressed at the cubital tunnel or at Guyon's canal
- Tap over the radial styloid or just distal to brachioradialis
Lower Extremity
Lateral Femoral Cutaneous Nerve (LFCN)
- The LFCN can be palpated as it exits the inguinal ligament region
- Tap the posterior tibial nerve directly over the flexor retinaculum posterior to the medial malleolus.
- Proximal radiation of symptoms towards calf is called Valleix phenomenon[4]
Pathology
Upper Extremity
- Median Nerve
- Radial Nerve
- Ulnar Nerve
Lower Extremity
Evidence
- De Smet et al[5]
- Sensitivity: 42%
- Specificity: 100%
- PPV: 100%
- NPV: 82%
- Chang et al[6]
- Sensitivity: 54%
- Specificity: 99%
- PPD: 97%
- NPD: 98%
- Diagnostic Accuracy: 84%
- Schiweterman et al[7]
- Sensitivity: 53%
- Specificity: no reported
- Beekman et al[8]
- Sensitivity: 62%
- Specificity:53%
- Positive Predictive Value: 77%
- Negative Predictive Value: 30%
- Paneyala et al[9]
- Sensitivity: 86.7%
- Specificity: 93.3%
- Positive Predictive Value: 92.9%
- Negative Predictive Value: 87.5%
- Diagnostic Accuracy: 90%
See Also
References
- ↑ Kitaoka, Hiroaki, et al. "JCS 2020 guideline on diagnosis and treatment of cardiac amyloidosis." Circulation Journal 84.9 (2020): 1610-1671.
- ↑ Image courtesy of uptodate.com, "The Tinel test for median nerve injury at the carpal tunnel"
- ↑ Image courtesy of https://orthoinfo.aaos.org/
- ↑ Merriman L, Turner W. Assessment of the lower limb. 2nd ed. London, UK: Churchill Livingstone; 2002.
- ↑ De Smet L, Steenwerckx A, Van den Bogaert G, Cnudde P, Fabry G. Value of clinical provocative tests in carpal tunnel syndrome. Acta Orthop Belg. 1995;61(3):177-82. Review. PubMed PMID: 8525813.
- ↑ Cheng, Christine J., et al. "Scratch collapse test for evaluation of carpal and cubital tunnel syndrome." The Journal of hand surgery 33.9 (2008): 1518-1524.
- ↑ Schwieterman, Braun et al. “Diagnostic accuracy of physical examination tests of the ankle/foot complex: a systematic review.” International journal of sports physical therapyvol. 8,4 (2013): 416-26.
- ↑ Beekman, Roy, et al. "The diagnostic value of provocative clinical tests in ulnar neuropathy at the elbow is marginal." Journal of Neurology, Neurosurgery & Psychiatry 80.12 (2009): 1369-1374.
- ↑ Paneyala, Shasthara, et al. "Efficacy of Clinical Tests in the Diagnosis of Meralgia Paresthetica: A Case Control Study." Case Reports in Medicine 2024.1 (2024): 5191280.
Created by:
John Kiel on 13 August 2019 03:51:14
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Last edited:
12 March 2026 17:13:25
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