Phalen's Test
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Search Strategy
Databases:Pubmed, ISI Web of Knowledge, Internet.
Keywords: Phalen’s test, Reverse Phalen test, Carpal tunnel syndrome, reability of phalen test, test carpal tunnel syndrome, symptoms of carpal tunnel syndrome
Definition/ Description
Patient makes the greatest possible active palmarflexion of wrist and hold it for at least 1 minute.[1C,2A]
Clinically Relevant Anatomy
Median Nerve
Formed by the spinal roots C6, C7, C8, T1.
C6 innervates -->lateral side forearm -->wrist extensors
C7 innervates --> middle finger -->wrist flexors
C8 innervates -->medial side of forearm, ring finger and little fingers flexors like
T1 innervates -->medial side of upper arm
Innervates: Pronator teres, Palmaris longus, Flexor carpi radialis, Flexor digitorum superficialis, Flexor digitorum profundus (lateral half), Pronator quadratus, Flexor pollicis longus, Abductor pollicis brevis, Opponens pollicis, Flexor pollicis brevis, and Lumbricals 1 & 2[3F]
Purpose
The phalen’s test is a provocative test used in the diagnosis of carpal tunnel syndrome. This occurs when the median nerve is compressed or squeezed at the wrist. [4C,5F] These are the most common complaints: pain and tingling of hands and fingers, numbness in the fingers. More specifically, at the height of thumb, forefinger and a part of the middle finger, and there can be pain in or near the wrist. [9F] It is possible that pain extends to the arm, and the pain is often worst at night. Other activities such as driving and typing may increase the symptoms. [5F] By carpal tunnel syndrome are the blood vessels in the tunnel also jammed making skin lesions present and these are localized on the median nerve territory. [6C]
Technique[1]
The implementation of the Phalen's test is done as follows: the therapist asks first the patient to put his/her elbows on the table. Then he asks the patient to free fall his/her wrist in maximal flexion and to hold this position for at least 1 minute. [4C] This maneuver does increase the pressure in the carpal tunnel. This makes the median nerve as it were, squeezed between the proximal edge of the transverse carpal ligament and the anterior margin of the distal end of the radius. [1C,7C]
Another way to describe the standard Phalen's test: the patient leaves his / her elbows bent between 0 ° -30 °. Then the therapist asks the patient to supinate his / her forearm. After this the therapist carries a maximum palmar flexion of the wrist and holds it for 60 seconds. During the test the patient will be asked to explain each 15 seconds what he / she feels. [7C]
A modified version of the Phalen's test is the Reverse Phalen's test. This test is performed by the patient's full wrist and finger extension to maintain for two minutes. The pressure on the carpal tunnel increases after 10 seconds. The longer we remain in this position, the greater the pressure on the wrist and carpal tunnel. While the pressure on the carpal tunnel at the standard Phalen test by platforms from 20 to 30 seconds increase. In a study comparing the changes in pressure Phalen and reverse Phalen's test, it was noted that the average pressure change for Phalen's test of 4 mm Hg in two minutes. While the average pressure changes in the carpal tunnel for the Reverse Phalen Test 34 mmHg for one minute and 42 mm Hg at two minutes respectively. [1C] Therefore we might conclude that the Reverse Phalen's test is more appropriate as a token challenge test than the standard Phalen test.
Positive test: The Phalen test and reverse Phalen's test positive have the same characters. The tests are positive when the test gives the same symptoms as that experienced with carpal tunnel syndrome. Main symptoms such as pain, numbness, tingling, paresthesia of hands and fingers. [2A,5F,8F] More specifically, at the height of thumb, forefinger and a part of the middle finger, and there can be pain in or near the wrist. [9F]
[2]
Evidence
Reability: One Studie has shown that the intraobserver reliability standard is moderate and that the interobserver reliability appears to be good. [10C] From another study shows the Phalen test sensitivity (0.64), specificity (0.75), positive likelihood ratio (2.54) and negative likelihood ratio (0.49) were measured. Therefore, when a positive Phalen's test is finding it is more likely that these changes are associated with nerve conduction studies in accordance with the carpal tunnel syndrome. [11C]
| Sensitivity | .77 |
| Specificity | .40 |
| +LR | 1.3 |
| -LR | .58 |
Key Research
- Development of a Clinical Prediction Rule for the Diagnosis of Carpal Tunnel Syndrom.
- Clinical diagnosis of carpal tunnel syndrome: old tests-new concepts.
- Carpal Tunnel Syndrome: Provocative Maneuvers.
Resources
Pubmed and ISI Web of Knowledge, Internet.
Recent Related Research (from Pubmed)
- Intraneural blood flow analysis during an intraoperative Phalen's test in carpal tunnel syndrome
- When is the Phalen's test of diagnostic value: an electrophysiologic analysis?
References
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- ↑ Magee DJ. 2002, Orthopedic Physical Assessment, 4th edition, Philadephia: Saunders
- ↑ Clinically Relevant Technologies, http://www.youtube.com/watch?v=e4zBw6gITgE; Accessed May 2011
