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
- Tinel’s sign is a commonly used diagnostic tool for evaluating damage or dysfunction of a specific nerve, and when assessing the radial nerve at the proximal forearm, a positive result is obtained when tapping the nerve elicits tingling or the feeling of “pins and needles,” particularly in the dorsoradial aspect of the hand.
Pathophysiology
- Patients with a proximal radial nerve entrapment like posterior interosseous nerve palsy sometimes have positive Tinel’s sign in the proximal dorsal forearm at the level of the Arcade of Froshse.
- Wartenberg syndrome is a pure sensory nerve entrapment where the sensory cutaneous branch of the radial nerve becomes entrapped as it exits between the brachioradialis and extensor carpi radialis longus tendons in the forearm.2
Instructions
- Obtain an accurate and complete patient history.
- Tap over the radial nerve in the proximal forearm.
- Ask the patient about any abnormal sensations (eg, tingling) in the hand being tested.
Related Signs and Tests2
- Tinel’s sign-ulnar nerve
- Finkelstein's test
Diagnostic Performance Characteristics
- A positive Tinel’s sign over the course of the sensory radial nerve is a common finding, but clinicians should be aware that this may also be positive in patients with more proximal pain generators, such as a lateral antebrachial cutaneous neuritis.3
