Tinel’s Test
Original Editor - Rachael Lowe
Top Contributors - Aminat Abolade, Vidya Acharya, Rachael Lowe, Blondeel Jonathan, Kim Jackson, Admin, Laura Ritchie, Kai A. Sigel, Tony Lowe, George Prudden and Claire Knott
Purpose
Tinel's sign is used to test for compression neuropathy. The sign has become associated with carpal tunnel syndrome diagnosis[1]and other compression neuropathies such as tarsal tunnel syndrome, cubital tunnel syndrome, or Guyon canal syndrome.[2]
Tinel sign, earlier known as the Hoffman-Tinel sign, was described by Paul Hoffmann and Jules Tinel as the "pins and needle feeling" when an injured nerve trunk is percussed at or distal to the site of a nerve lesion with resulting paresthesia experienced in the corresponding distal cutaneous distribution of an injured peripheral nerve. The Hoffman-Tinel sign is commonly used to indicate peripheral nerve fiber compression or regeneration. [2]
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.[3]
- The Tinel sign is elicited by the percussion of an injured nerve trunk at or distal to the site of the lesion.
- Positive test: The test is positive when a tingling or prickling sensation is felt in the distribution of the nerve.
- Sign indicates nerve regeneration.[1]
Conditions that have been associated with a Positive Tinel's sign[4]:
- Carpal Tunnel syndrome
- Cubital tunnel syndrome
- Radial nerve entrapment
- Tarsal tunnel syndrome
- Superficial peroneal neuropathy, and
- Thoracic outlet syndrome.
Evidence
A meta-analysis assessing the diagnostic validity (sensitivity (Sn) and specificity (Sp)) of physical examination maneuvers for carpal tunnel syndrome showed Tinel's sign had a median Sn/Sp of 0.51/0.90.[5] Another meta-analyses of (7 studies,748 CTS patients) suggest that the Tinel test had a low Sn and high Sp i.e., the pooled Sn was 0.45 and the pooled Sp was 0.78 [6]
| Sensitivity | Specificity | |
|---|---|---|
| Carpal Tunnel Syndrome[7] | 25% - 75% | 70% - 90% |
| Cubital tunnel syndrome[8] | 70% | 98% |
| Diabetic neuropathy[9] | 95% | 56% |
Resources
The following videos demonstrate the Tinel's sign at wrist, elbow and Brachial Plexus:
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
References
- ↑ 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.
- ↑ 2.0 2.1 Ho T, ME B. Hoffmann Tinel Sign.[Updated 2021 Nov 21]. StatPearls. Treasure Island (FL): StatPearls Publishing. 2022.
- ↑ Tinel J, Kaplan EB. The “tingling” sign in peripheral nerve lesions. Injuries to the major branches of peripheral nerves of the forearm. 1978:8.
- ↑ Moldaver JO. Tinel's sign. Its characteristics and significance. JBJS. 1978 Apr 1;60(3):412-4.
- ↑ 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).
- ↑ Dabbagh A, MacDermid JC, Yong J, Packham TL, Grewal R, Boutsikari EC. Diagnostic test accuracy of provocative maneuvers for the diagnosis of carpal tunnel syndrome: a systematic review and meta-analysis. Physical Therapy. 2023 Jun 1;103(6):pzad029.
- ↑ TINEL’S SI. Tinel’s sign and Phalen’s maneuver: physical signs of carpal tunnel syndrome. Hospital Physician. 2000 Jul:39.
- ↑ 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.
- ↑ 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.