Flick Sign
Top Contributors - Umamah Ejaz, Vidya Acharya, Ewa Jaraczewska and Matt Huey
Introduction
The flick maneuver, also known as the flick sign, is a less commonly used test for diagnosing carpal tunnel syndrome (CTS). To perform it, ask the patient what they typically do with their hands when symptoms are most severe. If they demonstrate a flicking or shaking motion similar to shaking down a thermometer, the test is considered positive. According to a study by Pryse-Phillips, the flick maneuver showed strong potential in evaluating CTS.[1]
Purpose
The Flick Sign is a simple neurological test commonly used to help diagnose carpal tunnel syndrome, the most frequent nerve entrapment condition.[2]
Technique
Patient Interview and Interpretation
- Interview Question: Ask the patient,"What do you usually do with your hand when the symptoms are at their worst?"
- What to Look For? Watch for the patient demonstrating a flicking or shaking motion of the hand/wrist—similar to shaking down a thermometer.
- Positive Result: The Flick Sign is considered positive if the patient either describes or performs this flicking motion to relieve symptoms like numbness, tingling, or pain.
- Clinical Notes: This is a patient-reported sign based on history, not a test performed by the clinician (unlike Phalen’s or Tinel’s tests).
It is commonly reported during nighttime symptoms, when patients wake up and instinctively flick their hands to relieve discomfort.[3]
The following video demonstrates the maneuver:
Evidence
A systematic review by D’Arcy et al. (2000) cited the original study by Pryse-Phillips (1984), which reported high diagnostic accuracy for the Flick Sign—93% sensitivity and 96% specificity. However, these results were later challenged, as other researchers were unable to replicate them using similar study designs.[5]
In 2004, Hansen et al. re-evaluated the Flick Sign and found significantly lower diagnostic accuracy, reporting a sensitivity of just 37% and a specificity of 74%. These findings highlight the limited clinical value of the Flick Sign in diagnosing Carpal Tunnel Syndrome.[1]
MacDermid et al.[6] looked at the average sensitivity and specificity across studies which were weighted by sample size. Across 4 studies with 5036 cases, the average sensitivity was found to be 47% and average specificity was found to be 62%.
Resources
References
- ↑ 1.0 1.1 Hansen PA, Micklesen P, Robinson LR. Clinical utility of the flick maneuver in diagnosing carpal tunnel syndrome. Am J Phys Med Rehabil. 2004 May;83(5):363-7.
- ↑ Wainner RS, Fritz JM, Irrgang JJ, Delitto A, Allison S, Boninger ML. Development of a clinical prediction rule for the diagnosis of carpal tunnel syndrome. Archives of Physical Medicine and Rehabilitation. 2005 Apr 1;86(4):609-18.
- ↑ Gok H, Ay S, Kutlay S. Are relieving maneuvers useful in diagnosis of carpal tunnel syndrome?. Archives of Rheumatology. 2008;23(4):129-34.
- ↑ Youtu.be. Available at: https://youtu.be/7K1l_Onb-0I?si=DV8_RO-pIGByTOPd (Accessed: May 14, 2025).
- ↑ D'Arcy, C. A., & McGee, S. (2000). The rational clinical examination. Does this patient have carpal tunnel syndrome?. JAMA, 283(23), 3110–3117. https://doi.org/10.1001/jama.283.23.3110
- ↑ MacDermid, J. C., & Wessel, J. (2004). Clinical diagnosis of carpal tunnel syndrome: a systematic review. Journal of hand therapy, 17(2), 309-319.