Historical Overview1
- 1915: Paul Hoffman (1884-1962), a German physiologist, described a sensation of “tingling” or “pins and needles” that could be elicited when an injured nerve was percussed and attributed the sign to nerve regeneration.
- 1915: Jules Tinel (1879-1952), a French neurologist, described a “tingling sensation” or “formication sign” after slight percussion of a nerve trunk after injury to which he attributed the sensation to the presence of growing axons.
Description
- Positive results are obtained when tapping the ulnar nerve at the medial epicondyle elicits tingling or the feeling of “pins and needles,” particularly in the ring and little fingers.
Pathophysiology
- May involve abnormal mechanosensitivity of the median nerve resulting in afferent discharge of regenerating nerves.
- On a cellular level, the sign may be caused by a hyper-excitable membrane.
Instructions2
- Tap over the ulnar nerve at the spot where it runs under the medial epicondyle
Variations3
- Some examiners find it easier to elicit Tinel's sign over the medial side of the humerus.
Related Signs and Tests4,5
- Froment sign
- Flexion sign
- Elbow flexion test
- Scratch collapse test
Diagnostic Performance Characteristics6
The diagnostic performance of Tinel’s sign has been incompletely studied. Some studies enroll only patients known to have ulnar neuropathy at the elbow, and patients known to be healthy. This design leaves out ambiguous, and other difficult-to-diagnose cases. Hence, studies of this sort overestimate the diagnostic performance of Tinel’s sign.
- One study that appears to have avoided this problem found that the sensitivity (proportion of actual positives that are correctly identified as such) of Tinel’s test for cubital tunnel syndrome was 62% and its specificity (proportion of actual negatives that are correctly identified as such) was 53%.
