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Tinel’s sign, elicited by tapping the wrist where the median nerve is located, can indicate carpal tunnel syndrome. However, nerve conduction studies are the best way to confirm the diagnosis. Symptoms include numbness and tingling in the middle finger, index finger, and thumb due to compression of the median nerve in the wrist. Other conditions can also cause a positive result.
Tinel’s sign is a physical exam finding that can help indicate the diagnosis of carpal tunnel syndrome. A positive sign can be elicited by tapping the wrist on the region where the median nerve is located. Patients with carpal tunnel syndrome will typically experience tingling and numbness in the middle finger, index finger, and thumb due to touch in this region. Although having a positive Tinel’s sign may suggest the presence of carpal tunnel syndrome, this diagnosis is best confirmed by doing nerve conduction studies.
To understand why Tinel’s sign is associated with carpal tunnel syndrome, it helps to understand why the syndrome develops. Part of the motor and sensory function of the hand is provided by the median nerve. Because the nerve has to pass through a narrow opening, the carpal tunnel in the wrist area can often become compressed. When the nerve is compressed in this region, carpal tunnel syndrome occurs, causing symptoms such as numbness or tingling in the fingers, pain in the fingers, poor hand muscle coordination, and weakness in the fingers. Symptoms typically affect the middle, forefinger, and thumb fingers, as well as the half of the palm located near those fingers.
Patients who complain of symptoms associated with carpal tunnel syndrome are often thoroughly examined by doctors to see if they really have the condition. One of the physical exam tests that can be done to check for the syndrome is Tinel’s sign. To perform this physical exam maneuver, a doctor or other healthcare professional touches the skin overlying the carpal tunnel, which is located in the center of the wrist, just below the palm. When patients experience numbness and tingling in the hand from this touch, this is considered a positive result.
Having a positive Tinel’s sign does not necessarily mean that a patient has carpal tunnel syndrome, as other conditions can also cause a positive patient result, such as problems causing compression of the median nerve in other locations. Patients with a condition called thoracic outlet syndrome, in which the origin of the median nerve is compressed in the lower neck or upper arm, may also have a positive result. Generally, however, about three-quarters of patients with a positive test result will have the syndrome.
Overall, Tinel’s sign is not the best method for diagnosing carpal tunnel syndrome, as only about half of carpal tunnel syndrome patients will test positive. Other physical exams, such as Phalen’s sign, may be checked. The confirmatory test, however, is performing nerve conduction studies. In this test, needles are inserted into points along the path of the median nerve and the rate at which electrical activity is conducted through the nerve is measured. Abnormal conduction findings confirm the diagnosis of carpal tunnel syndrome.
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