Tinel’s Test: Difference between revisions

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== Purpose<br> ==
== Purpose  ==


Tinel's sign is a way to detect irritated nerves<br>
Tinel's test is used to test for compression neuropathy, commonly in diagnosing [[Carpal Tunnel Syndrome|carpal tunnel syndrome]].<ref name=":1">Davis EN, Chung KC. [https://cdn.journals.lww.com/plasreconsurg/Fulltext/2004/08000/The_Tinel_Sign__A_Historical_Perspective.31.aspx The Tinel sign: a historical perspective.] Plastic and reconstructive surgery. 2004 Aug 1;114(2):494-9.</ref>


== Technique<br> ==
== Technique  ==


It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve. It takes its name from French neurologist Jules Tinel (1879-1952).[1][2][3]<br>The test is positive when there is pressure neuropathy of the nerve, like in the foot or ankle, or in the hand. When the nerve is not trapt behind a structure there will be a negative test and the patient will feel no pain. On the opposite when the nerve is trapt the patient will feel tingling’s in the distal area. (5)<br>When the nerve is trapt in the tarsal tunnel the sign can be called by tapping whit a reflex hammer just behind the medial malleolus. (5)<br>  
It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve.<ref>Tinel J, Kaplan EB. [https://litfl.com/wp-content/uploads/2020/07/Tinel-1915-The-22tingling22-sign-in-peripheral-nerve-lesions.pdf The “tingling” sign in peripheral nerve lesions.] Injuries to the major branches of peripheral nerves of the forearm. 1978:8.</ref> The Tinel sign is the tingling or prickling sensation elicited by the percussion of an injured nerve trunk at or distal to the site of the lesion. The sign also indicates nerve regeneration.<ref name=":1" />


<br>
'''Positive test:''' The test is positive when a tingling or prickling sensation is felt in the distribution of the nerve.


{| class="FCK__ShowTableBorders" cellspacing="1" cellpadding="1" width="100%"
<u>'''Conditions that have been associated with a Positive Tinel's sign'''</u><ref>Moldaver JO. [http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.899.9399&rep=rep1&type=pdf Tinel's sign. Its characteristics and significance.] JBJS. 1978 Apr 1;60(3):412-4.</ref>''':'''
|-
| {{#ev:youtube|sAhEhWYmkEQ|300}}<ref>Physiotutors. Tinel's Sign (Ankle)⎟Peripheral Nerve Injury. Available from: https://www.youtube.com/watch?v=sAhEhWYmkEQ</ref>  
| {{#ev:youtube|U8cPjPeZgFw|300}}<ref>Physiotutors. Tinel Sign: Wrist⎟Carpal Tunnel Syndrome. Available from: https://www.youtube.com/watch?v=U8cPjPeZgFw</ref>
|}


== Evidence  ==
* [[Carpal Tunnel Syndrome|Carpal Tunnel syndrome]]
* [[Cubital Tunnel Syndrome|Cubital tunnel syndrome]]
* [[Radial Tunnel Syndrome|Radial nerve entrapment]]
* [[Tarsal Tunnel syndrome|Tarsal tunnel syndrome]]
* Superficial peroneal neuropathy, and
* [https://physio-pedia.com/Thoracic_Outlet_Syndrome_(TOS)?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal Thoracic outlet syndrome].
<div class="row">
  <div class="col-md-6"><clinicallyrelevant id="84104175" title="Tinel's Sign at the Wrist" />
</div>
  <div class="col-md-6"> <clinicallyrelevant id="83473646" title="Tinel's Sign at the Elbow" />
</div>
</div>


<br>The tinel’s test is a specific test for the carpal tunnel syndrome and can be used as indication for medical management. (4)<br>It is concluded that it is difficult to identify patients with tibial nerve compression at the ankle or foot region reliably with traditional electrodiagnostic techniques, even in the absence of neuropathy, and that the presence of a positive "Tinel" sign over the tibial nerve in the tarsal tunnel can identify this as a site of chronic nerve compression. (5)<br>
<clinicallyrelevant id="83459545" title="Tinel's Sign for Brachial Plexus" />
 
== Resources  ==
 
Pubmed, medline
 
== References<br>  ==


== Evidence  ==
{| class="wikitable"
|+
!
!'''Sensitivity'''
!'''Specificity'''
|-
|Carpal Tunnel Syndrome<ref>TINEL’S SI. [http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.447.1845&rep=rep1&type=pdf Tinel’s sign and Phalen’s maneuver: physical signs of carpal tunnel syndrome]. Hospital Physician. 2000 Jul:39.</ref>
|25% - 75%
|70% - 90%
|-
|Cubital tunnel syndrome<ref>Pandey T, Slaughter AJ, Reynolds KA, Jambhekar K, David RM, Hasan SA. [https://pubs.rsna.org/doi/abs/10.1148/rg.342125061 Clinical orthopedic examination findings in the upper extremity: correlation with imaging studies and diagnostic efficacy]. Radiographics. 2014 Mar;34(2):e24-40.</ref>
|70%
|98%
|-
|Diabetic neuropathy<ref>Lee CH, Dellon AL. [https://journals.lww.com/annalsplasticsurgery/fulltext/2004/12000/Prognostic_Ability_of_Tinel_Sign_in_Determining.2.aspx Prognostic ability of Tinel sign in determining outcome for decompression surgery in diabetic and nondiabetic neuropathy]. Annals of plastic surgery. 2004 Dec 1;53(6):523-7.</ref>
|95%
|56%
|}


== References  ==
<references />
<references />
 
[[Category:Special_Tests]]
1. Tinel, J., Nerve wounds. London: Baillère, Tindall and Cox, 1917 (C)
[[Category:Primary Contact]]
 
[[Category:Elbow]]
2. Tinel, J. (1915) Le signe du fourmillement dans les lésions des nerfs périphériques. Presse médicale, 47, 388-389 (B)<br>3. Tinel, J. (1978) The "tingling sign" in peripheral nerve lesions (Translated by EB Kaplan). In: M. Spinner M (Ed.), Injuries to the Major Branches of Peripheral Nerves of the Forearm. (2nd ed.) (pp 8-13). Philadelphia: WD Saunders Co (B)
[[Category:Wrist]]
 
[[Category:Hand]]
4. Clinical diagnosis of carpal tunnel syndrome: old tests-new concepts. El Miedany Y, Ashour S, Youssef S, Mehanna A, Meky FA. Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt. (A)
[[Category:Assessment]]
 
[[Category:Elbow - Assessment and Examination]]
5. Dellon AL. | The four medial ankle tunnels: a critical review of perceptions of tarsal tunnel syndrome and neuropathy. | Neurosurg Clin N Am. | 2008 Oct;19(4):629-48, vii. (B)<br>
[[Category:Wrist - Assessment and Examination]]
[[Category:Special_Tests]] [[Category:Primary Contact]]
[[Category:Hand - Assessment and Examination]]
[[Category:Elbow - Special Tests]]
[[Category:Wrist - Special Tests]]
[[Category:Hand - Special Tests]]
[[Category:Neurodynamics]]

Latest revision as of 15:42, 23 May 2021

Purpose[edit | edit source]

Tinel's test is used to test for compression neuropathy, commonly in diagnosing carpal tunnel syndrome.[1]

Technique[edit | edit source]

It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve.[2] The Tinel sign is the tingling or prickling sensation elicited by the percussion of an injured nerve trunk at or distal to the site of the lesion. The sign also indicates nerve regeneration.[1]

Positive test: The test is positive when a tingling or prickling sensation is felt in the distribution of the nerve.

Conditions that have been associated with a Positive Tinel's sign[3]:

Tinel's Sign at the Wrist video provided by Clinically Relevant

Tinel's Sign at the Elbow video provided by Clinically Relevant

Tinel's Sign for Brachial Plexus video provided by Clinically Relevant

Evidence[edit | edit source]

Sensitivity Specificity
Carpal Tunnel Syndrome[4] 25% - 75% 70% - 90%
Cubital tunnel syndrome[5] 70% 98%
Diabetic neuropathy[6] 95% 56%

References[edit | edit source]

  1. ↑ 1.0 1.1 Davis EN, Chung KC. The Tinel sign: a historical perspective. Plastic and reconstructive surgery. 2004 Aug 1;114(2):494-9.
  2. ↑ Tinel J, Kaplan EB. The “tingling” sign in peripheral nerve lesions. Injuries to the major branches of peripheral nerves of the forearm. 1978:8.
  3. ↑ Moldaver JO. Tinel's sign. Its characteristics and significance. JBJS. 1978 Apr 1;60(3):412-4.
  4. ↑ TINEL’S SI. Tinel’s sign and Phalen’s maneuver: physical signs of carpal tunnel syndrome. Hospital Physician. 2000 Jul:39.
  5. ↑ Pandey T, Slaughter AJ, Reynolds KA, Jambhekar K, David RM, Hasan SA. Clinical orthopedic examination findings in the upper extremity: correlation with imaging studies and diagnostic efficacy. Radiographics. 2014 Mar;34(2):e24-40.
  6. ↑ Lee CH, Dellon AL. Prognostic ability of Tinel sign in determining outcome for decompression surgery in diabetic and nondiabetic neuropathy. Annals of plastic surgery. 2004 Dec 1;53(6):523-7.
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