Historical Perspective1
- 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.
- 1957: George Phalen (1911-1998), an American hand surgeon, was the first to describe the usefulness of the Tinel sign in diagnosing carpal tunnel syndrome (CTS).
Description1
- Tinel’s sign over the median nerve is described as a tingling sensation in the thumb, index and middle finger after light tapping or percussion over that nerve.
- A true Tinel’s sign may be uncomfortable for the patient, but it is never painful.
Pathophysiology1
- 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.
Instructions1
- Tap over the median nerve as it passes through the carpal tunnel in the wrist.
- The intensity of the tapping should be enough to cause the expected response while avoiding direct mechanical stimulation of the median nerve.
Variations2
- Single-finger strike: striking the load cell with the dominant middle finger only
- Double-finger strike: striking the load cell with the dominant index and middle finger together
- Preload: preloading with the non-dominant thumb and then striking the thumb with the dominant middle finger
Related Signs and Tests
- Phalen’s or Reversed Phalen’s maneuver
- Carpal tunnel compression test
- Durkan’s compression test
- Hoffmann-Tinel’s sign
- Hand elevation test
- Tourniquet test
- Pressure aesthesiometry
- Semmes-Weinstein monofilament testing
- Median nerve stress test
Diagnostic Performance Characteristics
| Citation | Sensitivity* | Specificity† | PPV‡ | NPV§ | Accuracyǁ |
| Szabo et al, 19993 | 64% | 71% | | | |
| Wiseman et al, 20034 | 62% | 93% | 88% | 76% | |
| MacDermid & Wessel, 20045 | 50% | 77% | | | |
| LaJoie et al, 20056 | 97% | 91% | | | |
| Wainner et al, 20057 | A=41%;
B=48% | A=58%;
B=67% | | | |
| AAOS, 20078 | 28-73% | 44-95% | | | |
| Cheng et al, 20089 | 32% | 99% | 96% | 59% | 65% |
| *Sensitivity: true positive rate; proportion of actual positives that are correctly identified as such |
| †Specificity: true negative rate; proportion of actual negatives that are correctly identified as such |
| ‡Positive predictive value (PPV): measure of precision; true positives / total number of positives (depends on prevalence) |
| §Negative predictive value (NPV): true negatives / total number of negatives (depends on prevalence) |
| ǁAccuracy: proportion of true results (positive and negative) in the population |
