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Phalen Sign

Exams and Signs

Description

  • The Phalen's Sign (Wrist Flexion Test) reproduces the symptoms of Carpal Tunnel Syndrome by increasing the pressure in the carpal tunnel by placing the wrists in palmar flexion.

Instructions

  • With the patient's forearm in pronation, examiner will place wrist in maximum flexion (90°) for 1 minute.
Presentation Photos and Related Diagrams
  • Phalen's Sign
    Phalen's Sign
Definition of Positive Result
  • A positive result is yielded if the patient experiences exacerbation of symptoms in the Median nerve distribution ie. reports pain or paresthesias in at least one finger innervated by the median nerve.
Definition of Negative Result
  • A negative result is yielded if the patient does not experience any exacerbation of symptoms along the median nerve distribution.
Comments and Pearls
  • Wrist flexion compresses median nerve thus temporarily decreasing epineural blood flow. This slight increase in ischemia can faciliate the demonstration of symptoms that otherwise might not be apparent.
Diagnoses Associated with Exams and Signs
Videos
Phalen's sign for Carpal Tunnel Syndrome
Phalen's test is part of the 35 second carpal tunnel syndrome complete exam
References

Cleland, J., & Koppenhaver, S. (2011). Wrist and Hand. In Netter's orthopaedic clinical examination an evidence-based approach (2nd ed., pp. 496-497). Philadelphia, PA: Saunders/Elsevier.

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