• A test to determine if there is entrapment of the median nerve in the carpal tunnel.

• Have the patient seat with elbow flexed and forearm in full supination.
• Begin by tapping gently with your finger over the area of the watch band on the median nerve.
• Continue percussing and move up towards the palmar creases.
• Return back to the watch band area then move radially towards the palmaris longus tendon.

• Positive (Abnormal):
  
• Tingling paresthesia (i.e. aching and numbness) is felt over the palmar aspect of the hand.

• Reports of sensitivity and specificity are vary but most agree this test has a low sensitivity and specificity.
• One study by Seror P (1987) showed that 63% of patients with electrophysiologically proved carpal tunnel syndrome had a positive Tinel's test.

• Considerable intra- and inter-examiner differences exist in the range of forces generated by the different Tinel's techniques that are used in clinical practice.

Editors:

• Anthony J. Busti, MD, PharmD, FNLA, FAHA

Last Reviewed:  September 2016

• Stewart DJ, et al. Tinel's sign and the carpal tunnel syndrome. Br Med J 1978;2(6145):1125-6.
• Seror P. Tinel's sign in the diagnosis of carpal tunnel syndrome. J Hand Surg Br 1987;12(3):364-5.
• Bickley LS et al. Bates' Guide to Physical Examination and History Taking. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2013;634.