Phalen’s Test
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Purpose
The Phalen’s test is a provocative test used in the diagnosis of carpal tunnel syndrome (CTS).
Technique
Instructions:[1]
- The patient is standing or sitting.
- The patient is asked to push the back of the hands (dorsal surface of the hands) together and hold this position for 30-60 seconds.
Reverse Phalen's test:
- The patient is standing or sitting.
- The patient is asked to push the palms together and hold this position for 30-60 seconds.
Positive test: Both Phalen test and Reverse Phalen's tests are considered positive when the patient's symptoms are reproduced: paresthesia (burning, tingling, numbness) along median nerve distribution.
Evidence
- In a meta-analysis studying 67 publications, it showed that Phalen's test had a median sensitivity of 0.70 and specificity of 0.80 for confirming CTS.[2]The study finds Phalen's test to be more diagnostically significant.
- According to a systematic review by MacDermid and Wessel, combined data from 29 studies that reviewed more than 3000 cases and 1600 controls showed Phalen’s test sensitivity of 0.68 and specificity of 0.73 in the diagnosis of CTS.[3]
- Meanwhile, Reverse Phalens’ test has higher specificity (0.78) compared to its sensitivity (0.57) which suggests that it might be more useful for ruling in rather than ruling out CTS.[3]
For better diagnostic accuracy, Phalen’s test should be used as an adjunct in confirming CTS.
Resources
The video below demonstrates the Phalen's Test:
Phalen’s Test video provided by Clinically Relevant
References
- ↑ Magee DJ. Orthopedic Physical Assessment, 6th edition. Elsevier Saunders, St. Louis, Missouri, 2014
- ↑ Ozdag Y, Hu Y, Hayes DS, Manzar S, Akoon A, Klena JC, Grandizio LC. Sensitivity and specificity of examination maneuvers for carpal tunnel syndrome: a meta-analysis. Cureus. 2023 Jul;15(7).
- ↑ 3.0 3.1 MacDermid JC, Wessel J. Clinical diagnosis of carpal tunnel syndrome: a systematic review. Journal of hand therapy. 2004 Apr 1;17(2):309-19.