The Pain Source

aka. “Tinel’s Test at the Wrist”

Tinel's Sign at the Wrist

Patient Position

• Seated (or standing)
• Elbow flexed, forearm supinated, and wrist in slight extension

Procedure Steps

• Examiner taps the median nerve as it travels through the carpal tunnel and also just proximal to it [can use reflex hammer or fingers]

Positive Sign / Significance

• Tingling or pain in the median nerve distribution (thumb, index, middle, and half of the ring fingers) = Carpal tunnel syndrome

• Also useful in identifying the most proximal point of nerve regeneration, or the most distal point of nerve degeneration.
• For more details on carpal tunnel syndrome (CTS), click here

Related Content:

• Phalen’s Test
• Ultrasound – Carpal Tunnel Injection
• Ultrasound – Wrist Exam
• Carpal Tunnel Syndrome: A Review
• Full Can Test

Patient Position

Phalen's Test

• Seated (or standing)
• Arms abducted, elbows flexed, forearms pronated, and the wrists fully flexed

Procedure Steps

• Patient is instructed to put the back of both hands together and place them in front of the their chest.
• Hold the position for 30-60 seconds (or until symptoms appear)

Positive Sign / Significance

• Reproduction of median nerve symptoms (pain, paresthesias) into the hand in the median nerve distribution = Carpal tunnel syndrome

Related Content:

• Tinel’s Sign at the Wrist
• Ultrasound – Carpal Tunnel Injection
• Ultrasound – Wrist Exam
• Carpal Tunnel Syndrome: A Review
• Full Can Test

Patient Position

• Seated or standing
• Elbow flexed to 90° and the forearm in the neutral position

Procedure Steps

• Instruct the patient to make a fist with their thumb covered-up inside.
• Examiner gently moves the hand/wrist into ulnar deviation.

Positive Sign / Significance

• Sharp pain at the distal radial wrist = De Quervain’s tenosynovitis

Comments

• De Quervain’s tenosynovitis is an inflammation of the tendon sheath around the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons.
• For excellent information on the injection technique for De Quervain’s tenosynovitis, go HERE.

Related Content:

• De Quervain’s Tenosynovitis Injection – Technique and Tips
• Ultrasound – Wrist Exam
• Posterior Interosseous Nerve
• Setup – Median Motor NCS
• Bicipital Tendon Sheath Injection – Technique and Tips